- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.91 / $3,697.00 / $7,365.00
| Facility | | $589.91 | $3,697.00 | $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
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.60 / $732.58 / $3,532.00
| Facility | | $446.60 | $732.58 | $3,532.00 |
- 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 |