- 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
- $3,529.97 / $3,529.97 / $3,529.97
| Facility | | $3,529.97 | $3,529.97 | $3,529.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $346.01 / $346.01 / $346.01
| Facility | AS | $346.01 | $346.01 | $346.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,889.53 / $3,602.04 / $4,642.08
| Facility | | $2,889.53 | $3,602.04 | $4,642.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $346.01 / $346.01 / $346.01
| Facility | AS | $346.01 | $346.01 | $346.01 |
- 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 |