- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $11,351.00
| Facility | | $100.00 | $2,331.21 | $11,351.00 |
- 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
- $913.96 / $2,000.36 / $2,070.38
| Facility | | $913.96 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $90.78 / $90.78 / $90.78
| Facility | AS | $90.78 | $90.78 | $90.78 |
- 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 |