- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,283.43 / $2,945.07
| Facility | | $100.00 | $1,283.43 | $2,945.07 |
- 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
- $892.03 / $892.03 / $892.03
| Facility | | $892.03 | $892.03 | $892.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.39 / $87.39 / $87.39
| Facility | AS | $87.39 | $87.39 | $87.39 |
- 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 |