- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.66 / $2,303.00 / $7,602.00
| Facility | | $453.66 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $148.00 / $1,676.00
| Facility | | $108.00 | $148.00 | $1,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,300.00 / $1,300.00
| Facility | | $55.00 | $1,300.00 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.60 / $101.32 / $101.32
| Facility | AS | $50.60 | $101.32 | $101.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $794.00 / $2,577.00
| Facility | | $294.00 | $794.00 | $2,577.00 |