- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.59 / $2,678.00 / $7,602.00
| Facility | | $330.59 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,324.00 / $4,528.00
| Facility | | $1,275.00 | $2,324.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $770.52 / $793.82
| Facility | | $55.00 | $770.52 | $793.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $41.18 / $79.38 / $79.38
| Facility | AS | $41.18 | $79.38 | $79.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |