- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,636.69 / $3,884.00
| Facility | | $900.00 | $2,636.69 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,425.86 / $1,425.86
| Facility | | $40.00 | $1,425.86 | $1,425.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,806.52
| Facility | | $488.00 | $675.00 | $1,806.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- 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 |