- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.31 / $1,400.00 / $21,510.02
| Facility | | $828.31 | $1,400.00 | $21,510.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.15 / $949.60 / $1,034.59
| Facility | | $828.15 | $949.60 | $1,034.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.64 / $891.64 / $891.64
| Facility | | $891.64 | $891.64 | $891.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.94 / $86.94 / $86.94
| Facility | AS | $86.94 | $86.94 | $86.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,083.19 / $28,083.19 / $28,083.19
| Facility | | $28,083.19 | $28,083.19 | $28,083.19 |