- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,473.70 / $3,311.73
| Facility | | $100.00 | $1,473.70 | $3,311.73 |
- 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
- $1,021.03 / $1,021.03 / $1,021.03
| Facility | | $1,021.03 | $1,021.03 | $1,021.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.07 / $100.07 / $100.07
| Facility | AS | $100.07 | $100.07 | $100.07 |
- 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 |