- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $9,859.00
| Facility | | $100.00 | $2,331.21 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,497.60 / $51,903.94 / $90,489.02
| Facility | | $1,497.60 | $51,903.94 | $90,489.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.30 / $1,487.30 / $1,487.30
| Facility | | $1,487.30 | $1,487.30 | $1,487.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.38 / $147.38 / $147.38
| Facility | AS | $147.38 | $147.38 | $147.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,629.00 / $12,629.00 / $12,629.00
| Facility | | $12,629.00 | $12,629.00 | $12,629.00 |