- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $6,165.95
| Facility | | $776.25 | $1,096.48 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $776.25 / $1,548.82
| Professional | | $758.58 | $776.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $3,630.78
| Facility | | $575.44 | $1,000.00 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $3,090.30
| Professional | | $776.25 | $776.25 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,548.82
| Facility | | $776.25 | $776.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $1,445.44
| Professional | | $776.25 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,148.15 / $8,511.38
| Facility | | $741.31 | $1,148.15 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $891.25
| Professional | | $776.25 | $776.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,548.13 / $8,912.51
| Facility | | $1,047.13 | $3,548.13 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $3,630.78
| Facility | | $575.44 | $1,000.00 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $3,090.30
| Professional | | $776.25 | $776.25 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $776.25 / $1,513.56
| Facility | | $707.95 | $776.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $776.25 / $954.99
| Professional | | $741.31 | $776.25 | $954.99 |