- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,358.64 / $9,859.00
| Facility | | $100.00 | $2,358.64 | $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
- $849.65 / $2,862.32 / $2,962.50
| Facility | | $849.65 | $2,862.32 | $2,962.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.97 / $84.97 / $84.97
| Facility | AS | $84.97 | $84.97 | $84.97 |
- 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 |