- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.55 / $6,400.80 / $8,209.29
| Facility | | $784.55 | $6,400.80 | $8,209.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.09 / $784.55 / $996.38
| Professional | | $766.09 | $784.55 | $996.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.32 / $876.85 / $8,459.92
| Facility | | $745.32 | $876.85 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.85 / $876.85 / $876.85
| Professional | | $876.85 | $876.85 | $876.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.55 / $784.55 / $784.55
| Facility | | $784.55 | $784.55 | $784.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.55 / $784.55 / $784.55
| Professional | | $784.55 | $784.55 | $784.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.55 / $1,016.08 / $1,857.00
| Facility | | $784.55 | $1,016.08 | $1,857.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.55 / $6,400.80 / $8,746.90
| Facility | | $784.55 | $6,400.80 | $8,746.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.86 / $784.55 / $1,059.14
| Professional | | $756.86 | $784.55 | $1,059.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.61 / $1,719.02 / $2,662.02
| Professional | | $1,000.61 | $1,719.02 | $2,662.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.55 / $784.55 / $784.55
| Facility | | $784.55 | $784.55 | $784.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.55 / $784.55 / $784.55
| Professional | | $784.55 | $784.55 | $784.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.18 / $728.18 / $801.00
| Facility | | $728.18 | $728.18 | $801.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.18 / $728.18 / $801.00
| Professional | | $728.18 | $728.18 | $801.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.17 / $769.17 / $1,113.99
| Professional | | $769.17 | $769.17 | $1,113.99 |