- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,848.15 / $16,288.02
| Facility | | $100.00 | $2,848.15 | $16,288.02 |
- 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
- $947.45 / $2,862.32 / $2,962.50
| Facility | | $947.45 | $2,862.32 | $2,962.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.06 / $94.06 / $94.06
| Facility | AS | $94.06 | $94.06 | $94.06 |
- 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 |