- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,673.91 / $9,859.00
| Facility | | $100.00 | $1,673.91 | $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
- $698.21 / $2,000.36 / $2,070.38
| Facility | | $698.21 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.23 / $69.23 / $69.23
| Facility | AS | $69.23 | $69.23 | $69.23 |
- 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 |