- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,556.00 / $5,923.00
| Facility | | $1,375.00 | $2,556.00 | $5,923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,072.00 / $3,931.00 / $5,258.00
| Facility | | $3,072.00 | $3,931.00 | $5,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.25 / $1,032.25 / $1,032.25
| Facility | | $1,032.25 | $1,032.25 | $1,032.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.04 / $848.60 / $1,296.30
| Professional | | $7.04 | $848.60 | $1,296.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.63 / $2,021.63 / $2,021.63
| Facility | | $2,021.63 | $2,021.63 | $2,021.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.00 / $2,200.00 / $6,244.00
| Facility | | $721.00 | $2,200.00 | $6,244.00 |