- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,548.13 / $8,912.51
| Facility | | $537.03 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,019.95 / $6,918.31
| Facility | | $1,698.24 | $3,019.95 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $1,659.59
| Professional | | $309.03 | $478.63 | $1,659.59 |
- 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
- $1,288.25 / $3,548.13 / $6,165.95
| Facility | | $1,288.25 | $3,548.13 | $6,165.95 |