- 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
- $1,814.27 / $1,814.27 / $1,814.27
| Facility | | $1,814.27 | $1,814.27 | $1,814.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.17 / $178.17 / $178.17
| Facility | AS | $178.17 | $178.17 | $178.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.62 / $1,764.03 / $2,372.53
| Facility | | $1,373.62 | $1,764.03 | $2,372.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.17 / $178.17 / $178.17
| Facility | AS | $178.17 | $178.17 | $178.17 |
- 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 |