- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.72 / $3,326.98 / $8,133.00
| Facility | | $198.72 | $3,326.98 | $8,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $4,500.00 / $10,303.00
| Facility | | $2,140.00 | $4,500.00 | $10,303.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.06 / $500.50 / $826.14
| Facility | | $374.06 | $500.50 | $826.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $11.30 / $11.30 / $11.30
| Facility | AS | $11.30 | $11.30 | $11.30 |
- 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 |