- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.73 / $7,838.38 / $7,838.38
| Facility | | $581.73 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.23 / $1,973.23 / $1,973.23
| Facility | | $1,973.23 | $1,973.23 | $1,973.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.42 / $193.42 / $193.42
| Facility | AS | $193.42 | $193.42 | $193.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,617.55 / $2,007.44 / $2,582.46
| Facility | | $1,617.55 | $2,007.44 | $2,582.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.42 / $193.42 / $193.42
| Facility | AS | $193.42 | $193.42 | $193.42 |
- 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 |