- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.58 / $2,483.02 / $2,770.80
| Facility | | $1,033.58 | $2,483.02 | $2,770.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.54 / $1,145.06 / $2,483.02
| Professional | | $773.54 | $1,145.06 | $2,483.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.00 / $486.00 / $876.00
| Facility | | $203.00 | $486.00 | $876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $289.87
| Professional | | $0.02 | $0.02 | $289.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.09 / $100.00 / $4,886.39
| Facility | | $66.09 | $100.00 | $4,886.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.86 / $520.86 / $520.86
| Professional | | $520.86 | $520.86 | $520.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $638.07 / $801.00
| Professional | | $393.93 | $638.07 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $100.00 / $100.00
| Facility | | $80.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $60.00 / $85.00
| Professional | | $30.00 | $60.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.54 / $1,145.06 / $3,128.61
| Facility | | $773.54 | $1,145.06 | $3,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.86 / $520.86 / $520.86
| Professional | | $520.86 | $520.86 | $520.86 |