- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.34 / $2,061.75 / $6,681.00
| Facility | | $381.34 | $2,061.75 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $150.00 / $1,959.00
| Facility | | $108.00 | $150.00 | $1,959.00 |
- 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
- $4,219.46 / $5,008.92 / $5,117.28
| Facility | | $4,219.46 | $5,008.92 | $5,117.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.37 / $151.57 / $151.57
| Facility | AS | $76.37 | $151.57 | $151.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,791.00
| Facility | | $294.00 | $808.00 | $2,791.00 |