- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,949.84 / $9,120.11
| Facility | | $776.25 | $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
- $691.83 / $1,000.00 / $1,174.90
| Facility | | $691.83 | $1,000.00 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,348.96 / $2,290.87
| Facility | | $851.14 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $15,135.61
| Facility | | $977.24 | $5,011.87 | $15,135.61 |