- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.15 / $1,709.36 / $7,702.00
| Facility | | $804.15 | $1,709.36 | $7,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,830.00 / $8,584.00 / $11,253.00
| Facility | | $5,830.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.35 / $1,245.83 / $1,437.16
| Facility | | $866.35 | $1,245.83 | $1,437.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.96 / $1,091.96 / $1,214.94
| Facility | | $1,091.96 | $1,091.96 | $1,214.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.27 / $108.27 / $108.27
| Facility | AS | $108.27 | $108.27 | $108.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $15,075.00
| Facility | | $973.00 | $4,639.00 | $15,075.00 |