- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $3,075.41 / $9,859.00
| Facility | | $100.00 | $3,075.41 | $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
- $969.02 / $3,906.58 / $4,043.31
| Facility | | $969.02 | $3,906.58 | $4,043.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $96.34 / $96.34 / $96.34
| Facility | AS | $96.34 | $96.34 | $96.34 |
- 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 |