- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.32 / $585.32 / $585.32
| Facility | | $585.32 | $585.32 | $585.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.32 / $585.32 / $754.30
| Professional | | $585.32 | $585.32 | $754.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.17 / $2,392.21 / $6,900.90
| Facility | | $758.17 | $2,392.21 | $6,900.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.29 / $862.14 / $1,308.23
| Professional | | $523.29 | $862.14 | $1,308.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.87 / $1,729.87 / $2,227.75
| Facility | | $1,421.87 | $1,729.87 | $2,227.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.20 / $905.92 / $905.92
| Professional | | $877.20 | $905.92 | $905.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.86 / $774.85 / $939.14
| Facility | | $680.86 | $774.85 | $939.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.03 / $680.86 / $1,609.50
| Professional | | $497.03 | $680.86 | $1,609.50 |
- 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
- $1,084.64 / $1,084.64 / $1,138.86
| Professional | | $1,084.64 | $1,084.64 | $1,138.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.27 / $692.27 / $692.27
| Professional | | $692.27 | $692.27 | $692.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.59 / $6,900.90 / $6,900.90
| Facility | | $2,818.59 | $6,900.90 | $6,900.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.00 / $668.33 / $1,308.23
| Professional | | $453.00 | $668.33 | $1,308.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.87 / $453.00 / $603.50
| Facility | | $0.87 | $453.00 | $603.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.31 / $668.33 / $1,308.23
| Professional | | $491.31 | $668.33 | $1,308.23 |