- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.55 / $5,045.00 / $6,915.00
| Facility | | $601.55 | $5,045.00 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.02 / $2,986.70 / $6,315.83
| Facility | | $1,082.02 | $2,986.70 | $6,315.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.67 / $651.67 / $651.67
| Facility | | $651.67 | $651.67 | $651.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.28 / $528.28 / $2,172.58
| Facility | | $528.28 | $528.28 | $2,172.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.97 / $628.48 / $1,137.94
| Professional | | $504.97 | $628.48 | $1,137.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $3,218.00 / $5,272.00
| Facility | | $625.00 | $3,218.00 | $5,272.00 |