- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.75 / $599.75 / $599.75
| Facility | | $599.75 | $599.75 | $599.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.75 / $661.07 / $1,050.15
| Professional | | $599.75 | $661.07 | $1,050.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.10 / $2,190.06 / $8,693.54
| Facility | | $694.10 | $2,190.06 | $8,693.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.32 / $1,045.22 / $1,340.49
| Professional | | $618.32 | $1,045.22 | $1,340.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.93 / $1,772.53 / $2,282.67
| Facility | | $1,456.93 | $1,772.53 | $2,282.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.84 / $1,058.20 / $1,058.20
| Professional | | $898.84 | $1,058.20 | $1,058.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.97 / $857.71 / $962.31
| Facility | | $739.97 | $857.71 | $962.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.13 / $857.71 / $1,591.50
| Professional | | $626.13 | $857.71 | $1,591.50 |
- 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
- $1,111.38 / $1,111.38 / $1,166.95
| Professional | | $1,111.38 | $1,111.38 | $1,166.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.07 / $1,007.07 / $1,007.07
| Professional | | $1,007.07 | $1,007.07 | $1,007.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.12 / $8,693.54 / $8,693.54
| Facility | | $4,098.12 | $8,693.54 | $8,693.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.64 / $733.74 / $1,340.49
| Professional | | $527.64 | $733.74 | $1,340.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.20 / $733.74 / $1,340.49
| Professional | | $536.20 | $733.74 | $1,340.49 |