- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.96 / $783.96 / $783.96
| Facility | | $783.96 | $783.96 | $783.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.07 / $783.96 / $1,050.29
| Professional | | $657.07 | $783.96 | $1,050.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,605.32 / $3,195.32 / $8,522.69
| Facility | | $1,605.32 | $3,195.32 | $8,522.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.88 / $1,361.68 / $1,822.28
| Professional | | $700.88 | $1,361.68 | $1,822.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,904.41 / $2,316.92 / $2,983.77
| Facility | | $1,904.41 | $2,316.92 | $2,983.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.89 / $1,592.00 / $1,592.00
| Professional | | $1,174.89 | $1,592.00 | $1,592.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.50 / $1,037.83 / $1,257.85
| Facility | | $870.50 | $1,037.83 | $1,257.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.47 / $870.50 / $1,560.00
| Professional | | $635.47 | $870.50 | $1,560.00 |
- 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
- $1,452.72 / $1,452.72 / $1,525.36
| Professional | | $1,452.72 | $1,452.72 | $1,525.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.96 / $854.96 / $854.96
| Professional | | $854.96 | $854.96 | $854.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,195.32 / $8,522.69 / $8,522.69
| Facility | | $3,195.32 | $8,522.69 | $8,522.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.35 / $959.10 / $1,752.19
| Professional | | $671.35 | $959.10 | $1,752.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.12 / $1,010.28 / $1,752.19
| Professional | | $683.12 | $1,010.28 | $1,752.19 |