- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,312.00 / $9,299.95 / $18,321.32
| Facility | | $4,312.00 | $9,299.95 | $18,321.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $602.53 / $602.53 / $602.53
| Facility | AS | $602.53 | $602.53 | $602.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,290.00 / $12,290.00 / $12,290.00
| Facility | | $12,290.00 | $12,290.00 | $12,290.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,734.45 / $19,517.43 / $28,442.50
| Facility | | $14,734.45 | $19,517.43 | $28,442.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $12,290.00 / $15,824.00
| Facility | | $3,028.00 | $12,290.00 | $15,824.00 |