- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,668.44 / $11,351.00
| Facility | | $100.00 | $2,668.44 | $11,351.00 |
- 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
- $858.91 / $2,000.36 / $2,070.38
| Facility | | $858.91 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.34 / $85.34 / $85.34
| Facility | AS | $85.34 | $85.34 | $85.34 |
- 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 |