- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.92 / $753.92 / $1,023.07
| Facility | | $753.92 | $753.92 | $1,023.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.85 / $753.92 / $786.16
| Professional | | $745.85 | $753.92 | $786.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.63 / $2,618.39 / $3,097.72
| Facility | | $897.63 | $2,618.39 | $3,097.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.26 / $897.63 / $2,271.00
| Professional | | $798.26 | $897.63 | $2,271.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.39 / $2,004.57 / $3,692.32
| Facility | | $1,170.39 | $2,004.57 | $3,692.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.07 / $876.07 / $876.07
| Facility | | $876.07 | $876.07 | $876.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.07 / $876.07 / $876.07
| Professional | | $876.07 | $876.07 | $876.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.63 / $1,418.26 / $8,090.00
| Facility | | $897.63 | $1,418.26 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.03 / $1,256.68 / $1,818.96
| Professional | | $1,030.03 | $1,256.68 | $1,818.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.92 / $753.92 / $1,216.07
| Professional | | $753.92 | $753.92 | $1,216.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.30 / $2,047.30 / $5,844.83
| Facility | | $2,047.30 | $2,047.30 | $5,844.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.92 / $886.96 / $6,219.11
| Professional | | $753.92 | $886.96 | $6,219.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.92 / $886.96 / $1,504.04
| Professional | | $753.92 | $886.96 | $1,504.04 |