- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,925.08 / $15,774.00
| Facility | | $100.00 | $1,925.08 | $15,774.00 |
- 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
- $1,200.77 / $2,862.32 / $2,962.50
| Facility | | $1,200.77 | $2,862.32 | $2,962.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.08 / $119.08 / $119.08
| Facility | AS | $119.08 | $119.08 | $119.08 |
- 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 |