- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.62 / $2,472.00 / $5,923.00
| Facility | | $308.62 | $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
- $1,470.87 / $1,920.23 / $2,053.42
| Facility | | $1,470.87 | $1,920.23 | $2,053.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.83 / $257.24 / $1,495.83
| Professional | | $117.83 | $257.24 | $1,495.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.83 / $3,030.83 / $3,030.83
| Facility | | $1,495.83 | $3,030.83 | $3,030.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.00 / $2,200.00 / $3,658.00
| Facility | | $721.00 | $2,200.00 | $3,658.00 |