- 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
- $1,784.51 / $1,784.51 / $1,784.51
| Facility | | $1,784.51 | $1,784.51 | $1,784.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.15 / $175.15 / $175.15
| Facility | AS | $175.15 | $175.15 | $175.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.21 / $1,769.36 / $2,334.13
| Facility | | $1,390.21 | $1,769.36 | $2,334.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.15 / $175.15 / $175.15
| Facility | AS | $175.15 | $175.15 | $175.15 |
- 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 |