- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.93 / $3,131.00 / $7,365.00
| Facility | | $381.93 | $3,131.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.89 / $364.70 / $932.00
| Facility | | $171.89 | $364.70 | $932.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.66 / $105.52 / $105.52
| Facility | AS | $54.66 | $105.52 | $105.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $760.00 / $1,300.00
| Facility | | $245.00 | $760.00 | $1,300.00 |