- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $3,507.83 / $9,859.00
| Facility | | $100.00 | $3,507.83 | $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
- $2,410.14 / $2,410.14 / $2,410.14
| Facility | | $2,410.14 | $2,410.14 | $2,410.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.31 / $238.31 / $238.31
| Facility | AS | $238.31 | $238.31 | $238.31 |
- 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 |