- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.01 / $742.01 / $742.01
| Facility | | $742.01 | $742.01 | $742.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.06 / $742.01 / $1,323.72
| Professional | | $714.06 | $742.01 | $1,323.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.29 / $1,381.80 / $9,225.87
| Facility | | $1,128.29 | $1,381.80 | $9,225.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.76 / $1,276.38 / $1,890.07
| Professional | | $833.76 | $1,276.38 | $1,890.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.26 / $191.26 / $196.84
| Facility | | $191.26 | $191.26 | $196.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.94 / $1,488.07 / $1,488.07
| Professional | | $1,243.94 | $1,488.07 | $1,488.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.37 / $799.37 / $1,643.28
| Facility | | $799.37 | $799.37 | $1,643.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.52 / $799.37 / $2,456.25
| Professional | | $145.52 | $799.37 | $2,456.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.45 / $1,355.45 / $1,355.45
| Professional | | $1,355.45 | $1,355.45 | $1,355.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.29 / $1,128.29 / $1,128.29
| Professional | | $1,128.29 | $1,128.29 | $1,128.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $9,225.87 / $9,225.87
| Facility | | $100.00 | $9,225.87 | $9,225.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.76 / $1,078.53 / $2,046.40
| Professional | | $833.76 | $1,078.53 | $2,046.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.76 / $1,355.45 / $2,558.00
| Professional | | $833.76 | $1,355.45 | $2,558.00 |