- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,897.79 / $16,218.10
| Facility | | $616.60 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $14,125.38 / $19,054.61
| Facility | | $4,570.88 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $575.44 / $645.65
| Facility | | $549.54 | $575.44 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,000.00 / $2,238.72
| Facility | | $870.96 | $1,000.00 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,762.47 / $10,964.78
| Facility | | $2,951.21 | $7,762.47 | $10,964.78 |