- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,382.23 / $9,859.00
| Facility | | $100.00 | $2,382.23 | $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
- $772.24 / $2,472.40 / $2,558.92
| Facility | | $772.24 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.84 / $76.84 / $76.84
| Facility | AS | $76.84 | $76.84 | $76.84 |
- 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 |