- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,193.40 / $2,757.41
| Facility | | $100.00 | $2,193.40 | $2,757.41 |
- 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
- $1,051.54 / $1,751.69 / $1,812.99
| Facility | | $1,051.54 | $1,751.69 | $1,812.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.15 / $105.15 / $105.15
| Facility | AS | $105.15 | $105.15 | $105.15 |
- 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 |