- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $804.73 / $2,678.80
| Facility | | $100.00 | $804.73 | $2,678.80 |
- 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
- $817.53 / $817.53 / $817.53
| Facility | | $817.53 | $817.53 | $817.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.75 / $81.75 / $81.75
| Facility | AS | $81.75 | $81.75 | $81.75 |
- 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 |