- 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
- $10,334.70 / $11,483.00 / $21,862.00
| Facility | | $10,334.70 | $11,483.00 | $21,862.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,401.97 / $2,472.40 / $2,558.92
| Facility | | $1,401.97 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.02 / $139.02 / $139.02
| Facility | AS | $139.02 | $139.02 | $139.02 |
- 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 |