- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $9,859.00
| Facility | | $100.00 | $2,331.21 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,495.37 / $74,732.42 / $90,489.02
| Facility | | $34,495.37 | $74,732.42 | $90,489.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,554.13 / $1,554.13 / $1,554.13
| Facility | | $1,554.13 | $1,554.13 | $1,554.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.35 / $154.35 / $154.35
| Facility | AS | $154.35 | $154.35 | $154.35 |
- 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 |