- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,320.46 / $9,859.00
| Facility | | $100.00 | $2,320.46 | $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
- $793.36 / $2,472.40 / $2,558.92
| Facility | | $793.36 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.34 / $79.34 / $79.34
| Facility | AS | $79.34 | $79.34 | $79.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,611.00 / $8,611.00 / $8,611.00
| Facility | | $8,611.00 | $8,611.00 | $8,611.00 |