- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,656.16 / $9,859.00
| Facility | | $100.00 | $1,656.16 | $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
- $1,031.88 / $2,000.36 / $2,070.38
| Facility | | $1,031.88 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.45 / $102.45 / $102.45
| Facility | AS | $102.45 | $102.45 | $102.45 |
- 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 |