- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,380.47 / $4,353.89
| Facility | | $100.00 | $1,380.47 | $4,353.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $9,458.00 / $17,400.00
| Facility | | $8,512.20 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.86 / $2,472.40 / $2,558.92
| Facility | | $1,048.86 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.89 / $104.89 / $104.89
| Facility | AS | $104.89 | $104.89 | $104.89 |
- 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 |