- 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
- $2,230.33 / $2,230.33 / $2,230.33
| Facility | | $2,230.33 | $2,230.33 | $2,230.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.55 / $218.55 / $218.55
| Facility | AS | $218.55 | $218.55 | $218.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,882.70 / $2,339.40 / $2,907.68
| Facility | | $1,882.70 | $2,339.40 | $2,907.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.55 / $218.55 / $218.55
| Facility | AS | $218.55 | $218.55 | $218.55 |
- 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 |