- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.67 / $2,747.00 / $5,454.00
| Facility | | $2,090.67 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $7,231.00
| Facility | | $953.00 | $3,729.00 | $7,231.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $497.05 / $497.05 / $1,001.40
| Facility | AS | $497.05 | $497.05 | $1,001.40 |
- 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
- $300.00 / $3,065.93 / $8,090.00
| Facility | | $300.00 | $3,065.93 | $8,090.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $21,730.28
| Facility | | $953.00 | $3,466.00 | $21,730.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $497.05 / $497.05 / $1,001.40
| Facility | AS | $497.05 | $497.05 | $1,001.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |