- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,225.92 / $9,515.83
| Facility | | $100.00 | $1,225.92 | $9,515.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $3,669.21 / $6,000.00
| Facility | | $3,302.10 | $3,669.21 | $6,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.32 / $5,257.46 / $5,441.47
| Facility | | $832.32 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.39 / $82.39 / $82.39
| Facility | AS | $82.39 | $82.39 | $82.39 |
- 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 |