- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,366.08 / $8,965.00
| Facility | | $100.00 | $1,366.08 | $8,965.00 |
- 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
- $423.32 / $1,306.21 / $1,351.93
| Facility | | $423.32 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $41.91 / $41.91 / $41.91
| Facility | AS | $41.91 | $41.91 | $41.91 |
- 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 |