- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.83 / $3,742.00 / $8,229.00
| Facility | | $85.83 | $3,742.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,297.33 / $1,383.82 / $1,530.00
| Facility | | $1,297.33 | $1,383.82 | $1,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.68 / $96.68 / $256.58
| Facility | | $96.68 | $96.68 | $256.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9.47 / $9.47 / $9.47
| Facility | AS | $9.47 | $9.47 | $9.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |