- 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
- $3,669.00 / $51,903.94 / $90,489.02
| Facility | | $3,669.00 | $51,903.94 | $90,489.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.07 / $1,548.07 / $1,548.07
| Facility | | $1,548.07 | $1,548.07 | $1,548.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $153.38 / $153.38 / $153.38
| Facility | AS | $153.38 | $153.38 | $153.38 |
- 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 |