- 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
- $1,806.52 / $1,806.52 / $1,806.52
| Facility | | $1,806.52 | $1,806.52 | $1,806.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.25 / $1,873.51 / $2,373.34
| Facility | | $1,517.25 | $1,873.51 | $2,373.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- 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 |