- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,177.00 / $16,876.59
| Facility | | $100.00 | $2,177.00 | $16,876.59 |
- 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
- $881.98 / $2,000.36 / $2,070.38
| Facility | | $881.98 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.65 / $87.65 / $87.65
| Facility | AS | $87.65 | $87.65 | $87.65 |
- 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 |