- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.66 / $2,173.00 / $4,841.00
| Facility | | $813.66 | $2,173.00 | $4,841.00 |
- 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
- $626.41 / $976.88 / $1,403.15
| Professional | | $626.41 | $976.88 | $1,403.15 |
- 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 |