- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,388.44 / $5,623.41
| Facility | | $1,819.70 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,981.07 / $5,888.44
| Facility | | $1,778.28 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | AS | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,754.23 / $8,511.38
| Facility | | $302.00 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,073.80 / $5,888.44
| Facility | | $1,862.09 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | AS | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $4,677.35
| Facility | | $1,000.00 | $2,884.03 | $4,677.35 |