- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.43 / $5,618.00 / $11,576.00
| Facility | | $77.43 | $5,618.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.88 / $400.00 / $2,530.00
| Facility | | $94.88 | $400.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9.25 / $9.25 / $9.25
| Facility | AS | $9.25 | $9.25 | $9.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.29 / $724.92 / $1,358.60
| Facility | | $532.29 | $724.92 | $1,358.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.00 / $1,485.00 / $4,456.00
| Facility | | $205.00 | $1,485.00 | $4,456.00 |