- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $2,832.00 / $7,365.00
| Facility | | $818.00 | $2,832.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.01 / $103.53 / $757.00
| Facility | | $59.01 | $103.53 | $757.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $16.85 / $16.85 / $31.79
| Facility | AS | $16.85 | $16.85 | $31.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $815.00 / $1,351.00
| Facility | | $245.00 | $815.00 | $1,351.00 |