- 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
- $3,669.00 / $20,162.41 / $35,151.03
| Facility | | $3,669.00 | $20,162.41 | $35,151.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.30 / $1,129.30 / $1,129.30
| Facility | | $1,129.30 | $1,129.30 | $1,129.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.81 / $111.81 / $111.81
| Facility | AS | $111.81 | $111.81 | $111.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,155.00 / $11,155.00 / $11,155.00
| Facility | | $11,155.00 | $11,155.00 | $11,155.00 |