- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,862.09 / $5,623.41
| Facility | | $537.03 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,981.07 / $7,244.36
| Facility | | $2,041.74 | $3,981.07 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,000.00 / $2,691.53
| Facility | | $302.00 | $1,000.00 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $1,737.80
| Professional | | $436.52 | $891.25 | $1,737.80 |
- 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
- $1,096.48 / $3,467.37 / $6,760.83
| Facility | | $1,096.48 | $3,467.37 | $6,760.83 |