- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.75 / $750.75 / $750.75
| Facility | | $750.75 | $750.75 | $750.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.91 / $750.75 / $1,019.09
| Professional | | $631.91 | $750.75 | $1,019.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.84 / $2,616.04 / $6,807.72
| Facility | | $1,067.84 | $2,616.04 | $6,807.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.19 / $1,121.24 / $1,677.98
| Professional | | $671.19 | $1,121.24 | $1,677.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.74 / $2,218.79 / $2,857.39
| Facility | | $1,823.74 | $2,218.79 | $2,857.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.13 / $1,524.56 / $1,524.56
| Professional | | $1,125.13 | $1,524.56 | $1,524.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.11 / $993.86 / $1,204.58
| Facility | | $908.11 | $993.86 | $1,204.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.92 / $662.92 / $1,494.00
| Professional | | $662.92 | $662.92 | $1,494.00 |
- 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
- $1,391.19 / $1,391.19 / $1,460.75
| Professional | | $1,391.19 | $1,391.19 | $1,460.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.65 / $1,091.65 / $1,091.65
| Professional | | $1,091.65 | $1,091.65 | $1,091.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,616.04 / $6,807.72 / $6,807.72
| Facility | | $2,616.04 | $6,807.72 | $6,807.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.91 / $918.47 / $1,677.98
| Professional | | $642.91 | $918.47 | $1,677.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.25 / $1,718.25 / $1,718.25
| Facility | | $1,718.25 | $1,718.25 | $1,718.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.91 / $918.47 / $1,391.19
| Professional | | $642.91 | $918.47 | $1,391.19 |