- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.30 / $2,678.00 / $7,602.00
| Facility | | $362.30 | $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 / $845.28 / $865.21
| Facility | | $55.00 | $845.28 | $865.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $44.87 / $86.52 / $86.52
| Facility | AS | $44.87 | $86.52 | $86.52 |
- 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 |