- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.76 / $2,472.00 / $5,923.00
| Facility | | $352.76 | $2,472.00 | $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
- $233.61 / $385.37 / $1,296.30
| Professional | | $233.61 | $385.37 | $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
- $1,282.00 / $2,625.00 / $7,138.00
| Facility | | $1,282.00 | $2,625.00 | $7,138.00 |