- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.83 / $2,678.00 / $7,602.00
| Facility | | $448.83 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $147.00 / $6,326.00
| Facility | | $108.00 | $147.00 | $6,326.00 |
- 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
- $3,476.34 / $4,137.14 / $5,000.00
| Facility | | $3,476.34 | $4,137.14 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.29 / $125.32 / $125.32
| Facility | AS | $63.29 | $125.32 | $125.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |