- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.24 / $681.24 / $681.24
| Facility | | $681.24 | $681.24 | $681.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.24 / $718.52 / $1,240.68
| Professional | | $681.24 | $718.52 | $1,240.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.91 / $3,632.48 / $7,438.91
| Facility | | $1,216.91 | $3,632.48 | $7,438.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.94 / $1,171.72 / $1,522.63
| Professional | | $711.94 | $1,171.72 | $1,522.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,702.44 / $2,013.38 / $2,592.85
| Facility | | $1,702.44 | $2,013.38 | $2,592.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.29 / $1,383.42 / $1,383.42
| Professional | | $1,148.29 | $1,383.42 | $1,383.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.71 / $891.71 / $891.71
| Facility | | $891.71 | $891.71 | $891.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.95 / $891.71 / $1,851.75
| Professional | | $650.95 | $891.71 | $1,851.75 |
- 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
- $1,262.39 / $1,262.39 / $1,325.51
| Professional | | $1,262.39 | $1,262.39 | $1,325.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.71 / $1,005.71 / $1,005.71
| Professional | | $1,005.71 | $1,005.71 | $1,005.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,242.82 / $7,438.91 / $7,438.91
| Facility | | $3,242.82 | $7,438.91 | $7,438.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.04 / $937.38 / $1,522.63
| Professional | | $609.04 | $937.38 | $1,522.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.94 / $937.38 / $1,522.63
| Professional | | $711.94 | $937.38 | $1,522.63 |