- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,672.54 / $9,859.00
| Facility | | $100.00 | $2,672.54 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,550.00 / $51,903.94 / $90,489.02
| Facility | | $26,550.00 | $51,903.94 | $90,489.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.20 / $1,815.20 / $1,815.20
| Facility | | $1,815.20 | $1,815.20 | $1,815.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $180.56 / $180.56 / $180.56
| Facility | AS | $180.56 | $180.56 | $180.56 |
- 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 |