- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.31 / $1,808.44 / $9,128.46
| Facility | | $850.31 | $1,808.44 | $9,128.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,315.00 / $3,778.00 / $9,135.00
| Facility | | $2,315.00 | $3,778.00 | $9,135.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.13 / $1,314.28 / $1,516.11
| Facility | | $912.13 | $1,314.28 | $1,516.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.44 / $1,154.44 / $1,154.44
| Facility | | $1,154.44 | $1,154.44 | $1,154.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.57 / $114.57 / $114.57
| Facility | AS | $114.57 | $114.57 | $114.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |