- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,905.46
| Professional | | $467.74 | $630.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $6,606.93
| Facility | | $1,230.27 | $1,412.54 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,000.00 / $1,412.54
| Professional | | $524.81 | $1,000.00 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,819.70 / $2,398.83
| Facility | | $1,513.56 | $1,819.70 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $1,258.93
| Professional | | $1,000.00 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $812.83 / $977.24
| Facility | | $776.25 | $812.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $812.83
| Professional | | $562.34 | $562.34 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,862.09
| Professional | | $1,230.27 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $912.01
| Professional | | $812.83 | $812.83 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,412.54 / $6,606.93
| Facility | | $1,230.27 | $1,412.54 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,047.13 / $1,412.54
| Professional | | $524.81 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.83 / $676.08 / $1,412.54
| Facility | | $0.83 | $676.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $741.31 / $1,230.27
| Professional | | $489.78 | $741.31 | $1,230.27 |