- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.17 / $1,060.09 / $7,278.00
| Facility | | $601.17 | $1,060.09 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.17 / $1,166.10 / $1,471.09
| Facility | | $601.17 | $1,166.10 | $1,471.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.62 / $9,447.00 / $14,257.00
| Facility | | $2,470.62 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,056.48 / $3,056.48
| Facility | | $55.00 | $3,056.48 | $3,056.48 |