- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $3,764.10 / $9,859.00
| Facility | | $100.00 | $3,764.10 | $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
- $1,567.52 / $5,257.46 / $5,441.47
| Facility | | $1,567.52 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $155.62 / $155.62 / $155.62
| Facility | AS | $155.62 | $155.62 | $155.62 |
- 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 |