- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.75 / $2,100.00 / $5,506.00
| Facility | | $320.75 | $2,100.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.40 / $3,300.84 / $5,432.89
| Facility | | $830.40 | $3,300.84 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.44 / $216.70 / $5,580.00
| Facility | | $157.44 | $216.70 | $5,580.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.35 / $40.35 / $75.98
| Facility | AS | $40.35 | $40.35 | $75.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |