- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,673.73 / $9,859.00
| Facility | | $100.00 | $1,673.73 | $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
- $1,126.75 / $5,257.46 / $5,441.47
| Facility | | $1,126.75 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.77 / $111.77 / $111.77
| Facility | AS | $111.77 | $111.77 | $111.77 |
- 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 |