- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $9,859.00
| Facility | | $100.00 | $2,331.21 | $9,859.00 |
- 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
- $821.34 / $2,000.36 / $2,070.38
| Facility | | $821.34 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.31 / $81.31 / $81.31
| Facility | AS | $81.31 | $81.31 | $81.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,949.00 / $9,949.00 / $9,949.00
| Facility | | $9,949.00 | $9,949.00 | $9,949.00 |