- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,089.07 / $9,859.00
| Facility | | $100.00 | $2,089.07 | $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
- $678.50 / $2,000.36 / $2,070.38
| Facility | | $678.50 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.22 / $67.22 / $67.22
| Facility | AS | $67.22 | $67.22 | $67.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,399.00 / $12,399.00 / $12,399.00
| Facility | | $12,399.00 | $12,399.00 | $12,399.00 |