- 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
- $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
- $1,341.75 / $1,341.75 / $1,341.75
| Facility | | $1,341.75 | $1,341.75 | $1,341.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.40 / $133.40 / $133.40
| Facility | AS | $133.40 | $133.40 | $133.40 |
- 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 |