- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,961.00 / $4,969.39 / $11,029.70
| Facility | | $2,961.00 | $4,969.39 | $11,029.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,520.00 / $2,916.00 / $3,384.00
| Professional | | $2,520.00 | $2,916.00 | $3,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $4,752.00 / $32,292.00
| Facility | | $59.30 | $4,752.00 | $32,292.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.34 / $3,600.00 / $17,640.00
| Facility | | $76.34 | $3,600.00 | $17,640.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,212.00 / $5,040.00 / $6,372.00
| Facility | | $4,212.00 | $5,040.00 | $6,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,331.26 / $3,762.00 / $10,883.88
| Facility | | $3,331.26 | $3,762.00 | $10,883.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.00 / $1,440.00 / $4,032.00
| Professional | | $1,440.00 | $1,440.00 | $4,032.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.00 / $2,340.00 / $5,882.53
| Professional | | $1,638.00 | $2,340.00 | $5,882.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,600.00 / $3,600.00 / $5,472.00
| Professional | | $3,600.00 | $3,600.00 | $5,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,600.00 / $3,600.00 / $3,600.00
| Professional | | $3,600.00 | $3,600.00 | $3,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,160.00 / $2,160.00 / $3,060.00
| Professional | | $2,160.00 | $2,160.00 | $3,060.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,925.00 / $6,084.00 / $10,799.10
| Facility | | $2,925.00 | $6,084.00 | $10,799.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,600.00 / $4,384.80 / $5,253.49
| Professional | | $3,600.00 | $4,384.80 | $5,253.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $2,160.00 / $3,888.00
| Professional | | $1,512.00 | $2,160.00 | $3,888.00 |