- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.64 / $2,678.00 / $7,602.00
| Facility | | $272.64 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $147.00 / $2,367.00
| Facility | | $110.00 | $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
- $256.48 / $3,461.67 / $26,542.00
| Facility | | $256.48 | $3,461.67 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $25.65 / $49.40 / $49.40
| Facility | AS | $25.65 | $49.40 | $49.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |