- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $3,131.00 / $8,485.00
| Facility | | $818.00 | $3,131.00 | $8,485.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $5,617.00 / $12,691.00
| Facility | | $2,114.00 | $5,617.00 | $12,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.61 / $486.45 / $5,000.00
| Facility | | $286.61 | $486.45 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.37 / $76.37 / $146.69
| Facility | AS | $76.37 | $76.37 | $146.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $1,097.00 / $9,475.00
| Facility | | $245.00 | $1,097.00 | $9,475.00 |