- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $354.81 / $1,698.24
| Facility | | $239.88 | $354.81 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $24.55 / $26.92
| Professional | | $24.55 | $24.55 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $524.81
| Facility | | $398.11 | $457.09 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $100.00
| Professional | | $0.02 | $0.02 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74,131.02 / $74,131.02 / $75,857.76
| Facility | | $74,131.02 | $74,131.02 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $398.11 / $10,000.00
| Professional | | $26.92 | $398.11 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,238.72 / $5,754.40
| Facility | | $602.56 | $2,238.72 | $5,754.40 |