- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,289.83 / $9,859.00
| Facility | | $100.00 | $1,289.83 | $9,859.00 |
- 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
- $311.69 / $2,472.40 / $2,558.92
| Facility | | $311.69 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $30.65 / $30.65 / $30.65
| Facility | AS | $30.65 | $30.65 | $30.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,949.00 / $9,949.00 / $9,949.00
| Facility | | $9,949.00 | $9,949.00 | $9,949.00 |