- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.27 / $2,472.00 / $5,923.00
| Facility | | $584.27 | $2,472.00 | $5,923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $4,589.00 / $6,006.00
| Facility | | $3,671.00 | $4,589.00 | $6,006.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.51 / $1,661.51 / $1,661.51
| Facility | | $1,661.51 | $1,661.51 | $1,661.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $597.54 / $1,631.69
| Professional | | $7.76 | $597.54 | $1,631.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,585.88 / $3,585.88 / $3,585.88
| Facility | | $3,585.88 | $3,585.88 | $3,585.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.00 / $2,661.00 / $9,042.00
| Facility | | $1,642.00 | $2,661.00 | $9,042.00 |