- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.22 / $3,811.00 / $8,273.00
| Facility | | $281.22 | $3,811.00 | $8,273.00 |
- 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
- $511.77 / $1,901.00 / $2,248.21
| Facility | | $511.77 | $1,901.00 | $2,248.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $14.95 / $14.95 / $14.95
| Facility | AS | $14.95 | $14.95 | $14.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |