- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.81 / $1,379.00 / $5,483.00
| Facility | | $366.81 | $1,379.00 | $5,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.36 / $2,511.37 / $3,876.42
| Facility | | $1,179.36 | $2,511.37 | $3,876.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.03 / $785.00 / $1,681.46
| Facility | | $217.03 | $785.00 | $1,681.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.31 / $329.38 / $910.34
| Professional | | $216.31 | $329.38 | $910.34 |
- 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
- $815.00 / $2,588.00 / $4,780.00
| Facility | | $815.00 | $2,588.00 | $4,780.00 |