- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.78 / $12,740.00 / $40,098.53
| Facility | | $1,806.78 | $12,740.00 | $40,098.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $10,302.00 / $39,498.00
| Facility | | $400.00 | $10,302.00 | $39,498.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.20 / $194.20 / $194.20
| Facility | AS | $194.20 | $194.20 | $194.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,460.00 / $21,065.00 / $32,051.00
| Facility | | $9,460.00 | $21,065.00 | $32,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,700.00 / $11,800.00 / $18,694.00
| Facility | | $3,700.00 | $11,800.00 | $18,694.00 |