- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,875.37 / $5,432.00
| Facility | | $900.00 | $2,875.37 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,594.63 / $1,594.63
| Facility | | $40.00 | $1,594.63 | $1,594.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $2,000.53
| Facility | | $488.00 | $675.00 | $2,000.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.33 / $196.33 / $196.33
| Facility | AS | $196.33 | $196.33 | $196.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,261.00 / $7,168.00
| Facility | | $385.00 | $1,261.00 | $7,168.00 |