- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.60 / $599.60 / $599.60
| Facility | | $599.60 | $599.60 | $599.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.60 / $649.08 / $878.94
| Professional | | $599.60 | $649.08 | $878.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.82 / $3,909.22 / $6,547.41
| Facility | | $1,227.82 | $3,909.22 | $6,547.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.97 / $1,019.43 / $1,340.15
| Professional | | $568.97 | $1,019.43 | $1,340.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.42 / $1,772.09 / $2,282.12
| Facility | | $1,498.42 | $1,772.09 | $2,282.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.60 / $1,057.94 / $1,057.94
| Professional | | $898.60 | $1,057.94 | $1,057.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.46 / $907.46 / $907.46
| Facility | | $907.46 | $907.46 | $907.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.45 / $907.46 / $1,630.13
| Professional | | $662.45 | $907.46 | $1,630.13 |
- 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
- $1,111.10 / $1,111.10 / $1,166.67
| Professional | | $1,111.10 | $1,111.10 | $1,166.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.91 / $1,044.91 / $1,044.91
| Professional | | $1,044.91 | $1,044.91 | $1,044.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,854.24 / $6,547.41 / $6,547.41
| Facility | | $2,854.24 | $6,547.41 | $6,547.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.19 / $684.64 / $1,340.15
| Professional | | $522.19 | $684.64 | $1,340.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.35 / $733.55 / $1,340.15
| Professional | | $566.35 | $733.55 | $1,340.15 |