- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,949.84 / $9,120.11
| Facility | | $812.83 | $1,949.84 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,073.80 / $9,549.93
| Facility | | $2,630.27 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $1,348.96
| Facility | | $741.31 | $1,047.13 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,412.54 / $2,290.87
| Facility | | $1,258.93 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |