- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.47 / $3,213.00 / $7,365.00
| Facility | | $739.47 | $3,213.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,050.00 / $9,663.00
| Facility | | $2,114.00 | $4,050.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.00 / $2,213.00 / $2,213.00
| Facility | | $2,213.00 | $2,213.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.47 / $1,203.80 / $4,332.00
| Facility | | $739.47 | $1,203.80 | $4,332.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.00 / $2,959.00 / $5,620.00
| Facility | | $1,694.00 | $2,959.00 | $5,620.00 |