- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.00 / $6,107.00
| Facility | | $2,528.00 | $2,894.00 | $6,107.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.00 / $5,508.58 / $15,970.61
| Facility | | $2,089.00 | $5,508.58 | $15,970.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.97 / $402.97 / $809.38
| Facility | AS | $402.97 | $402.97 | $809.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $3,000.00
| Facility | | $2,000.00 | $2,000.00 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.85 / $2,646.50 / $6,679.00
| Facility | | $1,636.85 | $2,646.50 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $17,386.05
| Facility | | $2,386.00 | $5,904.00 | $17,386.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.97 / $402.97 / $809.38
| Facility | AS | $402.97 | $402.97 | $809.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |