- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.50 / $3,863.00 / $7,602.00
| Facility | | $237.50 | $3,863.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $147.00 / $2,052.00
| Facility | | $110.00 | $147.00 | $2,052.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,032.40 / $6,821.50 / $32,000.00
| Facility | | $3,032.40 | $6,821.50 | $32,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.77 / $109.98 / $109.98
| Facility | AS | $55.77 | $109.98 | $109.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $814.00 / $2,823.00
| Facility | | $294.00 | $814.00 | $2,823.00 |