- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,640.42 / $6,067.00
| Facility | | $100.00 | $1,640.42 | $6,067.00 |
- 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
- $555.37 / $1,751.69 / $1,812.99
| Facility | | $555.37 | $1,751.69 | $1,812.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.10 / $55.10 / $55.10
| Facility | AS | $55.10 | $55.10 | $55.10 |
- 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 |