- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,903.58 / $14,784.63
| Facility | | $100.00 | $2,903.58 | $14,784.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,317.69 / $40,353.00 / $63,632.00
| Facility | | $36,317.69 | $40,353.00 | $63,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.09 / $5,257.46 / $5,441.47
| Facility | | $960.09 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.44 / $95.44 / $95.44
| Facility | AS | $95.44 | $95.44 | $95.44 |
- 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 |