- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $6,074.38
| Facility | | $100.00 | $2,331.21 | $6,074.38 |
- 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
- $2,047.60 / $5,257.46 / $5,441.47
| Facility | | $2,047.60 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.96 / $202.96 / $202.96
| Facility | AS | $202.96 | $202.96 | $202.96 |
- 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 |