- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.13 / $610.13 / $610.13
| Facility | | $610.13 | $610.13 | $610.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.61 / $610.13 / $610.13
| Professional | | $562.61 | $610.13 | $610.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.58 / $1,249.68 / $1,562.10
| Professional | | $1,178.58 | $1,249.68 | $1,562.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.02 / $950.81 / $1,637.36
| Facility | | $589.02 | $950.81 | $1,637.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.68 / $1,187.80 / $4,295.84
| Professional | | $712.68 | $1,187.80 | $4,295.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.32 / $1,425.41 / $1,870.86
| Facility | | $1,191.32 | $1,425.41 | $1,870.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.60 / $1,300.57 / $1,775.91
| Professional | | $1,053.60 | $1,300.57 | $1,775.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.80 / $1,013.94 / $1,156.01
| Professional | | $783.80 | $1,013.94 | $1,156.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.68 / $1,184.35 / $1,674.51
| Professional | | $712.68 | $1,184.35 | $1,674.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.40 / $1,402.80 / $1,458.90
| Professional | | $1,192.40 | $1,402.80 | $1,458.90 |