- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.48 / $508.48 / $508.48
| Facility | | $508.48 | $508.48 | $508.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.77 / $214.25 / $661.02
| Professional | | $194.77 | $214.25 | $661.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.96 / $6,592.43 / $6,592.43
| Facility | | $1,011.96 | $6,592.43 | $6,592.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.51 / $332.26 / $6,299.47
| Professional | | $172.51 | $332.26 | $6,299.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,712.14 / $1,712.14 / $2,014.29
| Professional | | $1,712.14 | $1,712.14 | $2,014.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.96 / $6,592.43 / $6,592.43
| Facility | | $1,011.96 | $6,592.43 | $6,592.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.51 / $332.26 / $6,299.47
| Professional | | $172.51 | $332.26 | $6,299.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.51 / $278.51 / $3,559.54
| Professional | | $172.51 | $278.51 | $3,559.54 |