- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,260.57 / $9,859.00
| Facility | | $100.00 | $2,260.57 | $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
- $738.76 / $2,472.40 / $2,558.92
| Facility | | $738.76 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.37 / $73.37 / $73.37
| Facility | AS | $73.37 | $73.37 | $73.37 |
- 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 |