- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.48 / $2,678.00 / $7,602.00
| Facility | | $492.48 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,387.00 / $6,217.00
| Facility | | $1,417.00 | $2,387.00 | $6,217.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,300.00 / $1,315.64
| Facility | | $55.00 | $1,300.00 | $1,315.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $44.13 / $104.62 / $104.62
| Facility | AS | $44.13 | $104.62 | $104.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,698.00 / $4,664.00
| Facility | | $1,270.00 | $2,698.00 | $4,664.00 |