- 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
- $1,021.84 / $2,862.32 / $2,962.50
| Facility | | $1,021.84 | $2,862.32 | $2,962.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.08 / $102.08 / $102.08
| Facility | AS | $102.08 | $102.08 | $102.08 |
- 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 |