- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $7,854.08
| Facility | | $100.00 | $2,331.21 | $7,854.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $20,162.41 / $35,151.03
| Facility | | $8,512.20 | $20,162.41 | $35,151.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,606.76 / $2,606.76 / $2,606.76
| Facility | | $2,606.76 | $2,606.76 | $2,606.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.88 / $257.88 / $257.88
| Facility | AS | $257.88 | $257.88 | $257.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |