- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $721.58 / $6,067.00
| Facility | | $100.00 | $721.58 | $6,067.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,334.70 / $11,483.00 / $21,862.00
| Facility | | $10,334.70 | $11,483.00 | $21,862.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.30 / $491.30 / $491.30
| Facility | | $491.30 | $491.30 | $491.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $48.50 / $48.50 / $48.50
| Facility | AS | $48.50 | $48.50 | $48.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,399.00 / $12,399.00 / $12,399.00
| Facility | | $12,399.00 | $12,399.00 | $12,399.00 |