- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,959.77 / $10,669.47
| Facility | | $100.00 | $2,959.77 | $10,669.47 |
- 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
- $877.51 / $2,000.36 / $2,070.38
| Facility | | $877.51 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.09 / $87.09 / $87.09
| Facility | AS | $87.09 | $87.09 | $87.09 |
- 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 |