- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,639.16 / $12,690.90
| Facility | | $100.00 | $1,639.16 | $12,690.90 |
- 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
- $1,255.08 / $5,257.46 / $5,441.47
| Facility | | $1,255.08 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.52 / $124.52 / $124.52
| Facility | AS | $124.52 | $124.52 | $124.52 |
- 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 |