- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,513.56 / $5,495.41
| Facility | | $758.58 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,398.83 / $4,365.16
| Facility | | $1,479.11 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,000.00 / $1,202.26
| Facility | | $707.95 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,659.59
| Facility | | $1,348.96 | $1,348.96 | $1,659.59 |
- 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
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |