- 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
- $1,229.08 / $1,229.08 / $1,229.08
| Facility | | $1,229.08 | $1,229.08 | $1,229.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.64 / $120.64 / $120.64
| Facility | AS | $120.64 | $120.64 | $120.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.53 / $1,241.58 / $1,615.92
| Facility | | $975.53 | $1,241.58 | $1,615.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.64 / $120.64 / $120.64
| Facility | AS | $120.64 | $120.64 | $120.64 |
- 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 |