- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,260.00 / $5,506.00
| Facility | | $627.00 | $2,260.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.10 / $1,107.20 / $1,810.96
| Facility | | $294.10 | $1,107.20 | $1,810.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.97 / $65.01 / $1,448.00
| Facility | | $41.97 | $65.01 | $1,448.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.13 / $20.13 / $20.13
| Facility | AS | $20.13 | $20.13 | $20.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,326.00
| Facility | | $704.00 | $1,535.00 | $2,326.00 |