- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,051.36 / $9,859.00
| Facility | | $100.00 | $1,051.36 | $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
- $1,207.14 / $5,257.46 / $5,441.47
| Facility | | $1,207.14 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.75 / $119.75 / $119.75
| Facility | AS | $119.75 | $119.75 | $119.75 |
- 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 |