- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.15 / $719.15 / $719.15
| Facility | | $719.15 | $719.15 | $719.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.15 / $719.15 / $1,054.15
| Professional | | $719.15 | $719.15 | $1,054.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.63 / $4,688.67 / $7,852.81
| Facility | | $1,472.63 | $4,688.67 | $7,852.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.41 / $1,222.68 / $1,607.36
| Professional | | $682.41 | $1,222.68 | $1,607.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,797.16 / $2,125.40 / $2,737.11
| Facility | | $1,797.16 | $2,125.40 | $2,737.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.77 / $1,077.77 / $1,268.86
| Professional | | $1,077.77 | $1,077.77 | $1,268.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.33 / $941.33 / $1,209.75
| Facility | | $941.33 | $941.33 | $1,209.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.17 / $941.33 / $1,954.88
| Professional | | $687.17 | $941.33 | $1,954.88 |
- 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
- $1,332.63 / $1,332.63 / $1,399.26
| Professional | | $1,332.63 | $1,332.63 | $1,399.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.58 / $1,201.58 / $1,201.58
| Professional | | $1,201.58 | $1,201.58 | $1,201.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,423.25 / $7,852.81 / $7,852.81
| Facility | | $3,423.25 | $7,852.81 | $7,852.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.29 / $821.14 / $1,607.36
| Professional | | $626.29 | $821.14 | $1,607.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.97 / $879.82 / $1,607.36
| Professional | | $636.97 | $879.82 | $1,607.36 |