- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,402.06 / $11,351.00
| Facility | | $100.00 | $2,402.06 | $11,351.00 |
- 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
- $749.93 / $2,000.36 / $2,070.38
| Facility | | $749.93 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.34 / $74.34 / $74.34
| Facility | AS | $74.34 | $74.34 | $74.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,155.00 / $11,155.00 / $11,155.00
| Facility | | $11,155.00 | $11,155.00 | $11,155.00 |