- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,488.49 / $3,313.74
| Facility | | $100.00 | $1,488.49 | $3,313.74 |
- 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
- $694.45 / $2,472.40 / $2,558.92
| Facility | | $694.45 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.45 / $69.45 / $69.45
| Facility | AS | $69.45 | $69.45 | $69.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,565.00 / $9,565.00 / $9,565.00
| Facility | | $9,565.00 | $9,565.00 | $9,565.00 |