- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,090.30 / $13,182.57
| Facility | | $977.24 | $3,090.30 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $12,302.69
| Facility | | $3,467.37 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $933.25 / $1,202.26
| Facility | | $676.08 | $933.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $3,090.30
| Facility | | $1,258.93 | $1,258.93 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- 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 |