- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.37 / $2,678.00 / $7,602.00
| Facility | | $366.37 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $147.00 / $2,367.00
| Facility | | $108.00 | $147.00 | $2,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.51 / $2,000.00 / $4,272.08
| Facility | | $325.51 | $2,000.00 | $4,272.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $32.54 / $63.40 / $63.40
| Facility | AS | $32.54 | $63.40 | $63.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |