- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.47 / $2,173.00 / $4,841.00
| Facility | | $453.47 | $2,173.00 | $4,841.00 |
- 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
- $1,009.94 / $1,009.94 / $1,009.94
| Facility | | $1,009.94 | $1,009.94 | $1,009.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.50 / $297.33 / $1,046.24
| Professional | | $158.50 | $297.33 | $1,046.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.24 / $2,263.96 / $2,263.96
| Facility | | $1,046.24 | $2,263.96 | $2,263.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.00 / $2,331.00 / $7,138.00
| Facility | | $1,282.00 | $2,331.00 | $7,138.00 |