- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.50 / $563.50 / $563.50
| Facility | | $563.50 | $563.50 | $563.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.50 / $564.46 / $972.65
| Professional | | $563.50 | $564.46 | $972.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.10 / $2,156.35 / $6,077.59
| Facility | | $694.10 | $2,156.35 | $6,077.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.25 / $915.52 / $1,259.44
| Professional | | $577.25 | $915.52 | $1,259.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.85 / $1,665.36 / $2,144.67
| Facility | | $1,368.85 | $1,665.36 | $2,144.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.96 / $1,144.29 / $1,144.29
| Professional | | $928.96 | $1,144.29 | $1,144.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.98 / $930.44 / $930.44
| Facility | | $745.98 | $930.44 | $930.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.22 / $930.44 / $1,618.88
| Professional | | $679.22 | $930.44 | $1,618.88 |
- 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
- $1,044.18 / $1,044.18 / $1,096.39
| Professional | | $1,044.18 | $1,044.18 | $1,096.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.14 / $735.14 / $735.14
| Professional | | $735.14 | $735.14 | $735.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,834.41 / $6,077.59 / $6,077.59
| Facility | | $2,834.41 | $6,077.59 | $6,077.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.78 / $689.39 / $1,259.44
| Professional | | $503.78 | $689.39 | $1,259.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.07 / $689.39 / $1,259.44
| Professional | | $533.07 | $689.39 | $1,259.44 |