- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,078.23 / $24,094.80
| Facility | | $100.00 | $2,078.23 | $24,094.80 |
- 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
- $708.63 / $1,306.21 / $1,351.93
| Facility | | $708.63 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.80 / $70.80 / $70.80
| Facility | AS | $70.80 | $70.80 | $70.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,949.00 / $9,949.00 / $9,949.00
| Facility | | $9,949.00 | $9,949.00 | $9,949.00 |