- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.04 / $800.04 / $800.04
| Facility | | $800.04 | $800.04 | $800.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.61 / $800.04 / $1,031.01
| Professional | | $737.61 | $800.04 | $1,031.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $2,787.80 / $8,119.13
| Facility | | $1,150.00 | $2,787.80 | $8,119.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.83 / $1,207.50 / $1,788.15
| Professional | | $670.83 | $1,207.50 | $1,788.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.49 / $2,364.48 / $3,045.00
| Facility | | $1,943.49 | $2,364.48 | $3,045.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.00 / $1,411.60 / $1,411.60
| Professional | | $1,199.00 | $1,411.60 | $1,411.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.38 / $1,059.13 / $1,283.68
| Facility | | $888.38 | $1,059.13 | $1,283.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.52 / $888.38 / $1,592.25
| Professional | | $648.52 | $888.38 | $1,592.25 |
- 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
- $1,482.54 / $1,482.54 / $1,556.67
| Professional | | $1,482.54 | $1,482.54 | $1,556.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.26 / $1,131.26 / $1,131.26
| Professional | | $1,131.26 | $1,131.26 | $1,131.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,787.80 / $8,119.13 / $8,119.13
| Facility | | $2,787.80 | $8,119.13 | $8,119.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.00 / $913.50 / $1,788.15
| Professional | | $609.00 | $913.50 | $1,788.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.23 / $913.50 / $1,763.37
| Professional | | $619.23 | $913.50 | $1,763.37 |