- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $7,117.49
| Facility | | $100.00 | $2,331.21 | $7,117.49 |
- 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
- $2,408.56 / $5,257.46 / $5,441.47
| Facility | | $2,408.56 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.75 / $238.75 / $238.75
| Facility | AS | $238.75 | $238.75 | $238.75 |
- 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 |