- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.41 / $1,058.49 / $5,091.00
| Facility | | $483.41 | $1,058.49 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,111.21 / $3,770.65 / $8,224.27
| Facility | | $2,111.21 | $3,770.65 | $8,224.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $1,378.17 / $1,538.56
| Facility | | $463.00 | $1,378.17 | $1,538.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.09 / $805.64 / $2,046.41
| Professional | | $439.09 | $805.64 | $2,046.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.00 / $1,763.00 / $4,256.00
| Facility | | $807.00 | $1,763.00 | $4,256.00 |