- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.10 / $2,303.00 / $7,932.63
| Facility | | $439.10 | $2,303.00 | $7,932.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $142.00 / $388.00
| Facility | | $108.00 | $142.00 | $388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,055.15 / $1,087.32
| Facility | | $55.00 | $1,055.15 | $1,087.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.66 / $108.73 / $108.73
| Facility | AS | $54.66 | $108.73 | $108.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |