- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $7,838.38
| Facility | | $1,000.00 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.78 / $2,318.78 / $2,318.78
| Facility | | $2,318.78 | $2,318.78 | $2,318.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.05 / $227.05 / $227.05
| Facility | AS | $227.05 | $227.05 | $227.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.89 / $2,175.09 / $3,042.28
| Facility | | $1,355.89 | $2,175.09 | $3,042.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.05 / $227.05 / $227.05
| Facility | AS | $227.05 | $227.05 | $227.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $4,616.00 / $17,636.00
| Facility | | $755.00 | $4,616.00 | $17,636.00 |