- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,155.65 / $9,859.00
| Facility | | $100.00 | $2,155.65 | $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
- $741.37 / $2,472.40 / $2,558.92
| Facility | | $741.37 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.78 / $73.78 / $73.78
| Facility | AS | $73.78 | $73.78 | $73.78 |
- 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 |