- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,570.88 / $11,481.54
| Facility | | $870.96 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,912.51 / $16,982.44
| Facility | | $3,388.44 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,230.27 / $4,073.80
| Facility | | $398.11 | $1,230.27 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $17,782.79
| Facility | | $2,884.03 | $8,511.38 | $17,782.79 |