- 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
- $1,601.71 / $1,601.71 / $1,601.71
| Facility | | $1,601.71 | $1,601.71 | $1,601.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.62 / $156.62 / $156.62
| Facility | AS | $156.62 | $156.62 | $156.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.44 / $1,518.94 / $2,103.44
| Facility | | $942.44 | $1,518.94 | $2,103.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.62 / $156.62 / $156.62
| Facility | AS | $156.62 | $156.62 | $156.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $6,599.00 / $7,158.00
| Facility | | $936.00 | $6,599.00 | $7,158.00 |