- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,991.30 / $9,859.00
| Facility | | $100.00 | $2,991.30 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,495.37 / $74,126.09 / $90,489.02
| Facility | | $34,495.37 | $74,126.09 | $90,489.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.18 / $2,043.18 / $2,043.18
| Facility | | $2,043.18 | $2,043.18 | $2,043.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.55 / $202.55 / $202.55
| Facility | AS | $202.55 | $202.55 | $202.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,629.00 / $12,629.00 / $12,629.00
| Facility | | $12,629.00 | $12,629.00 | $12,629.00 |