- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,384.00 / $8,201.16 / $23,616.00
| Facility | | $3,384.00 | $8,201.16 | $23,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,268.00 / $3,384.00 / $3,492.00
| Professional | | $2,268.00 | $3,384.00 | $3,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,780.00 / $5,760.00 / $14,873.04
| Facility | | $3,780.00 | $5,760.00 | $14,873.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,558.91 / $7,480.86 / $27,000.00
| Professional | | $3,558.91 | $7,480.86 | $27,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,744.00 / $7,652.50 / $9,295.65
| Facility | | $3,744.00 | $7,652.50 | $9,295.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,240.00 / $3,600.00 / $9,000.00
| Facility | | $3,240.00 | $3,600.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,240.00 / $3,600.00 / $9,000.00
| Professional | | $3,240.00 | $3,600.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,240.00 / $3,960.00 / $6,300.00
| Facility | | $3,240.00 | $3,960.00 | $6,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.00 / $6,300.00 / $10,800.00
| Facility | | $3,600.00 | $6,300.00 | $10,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,240.00 / $4,500.00 / $5,436.00
| Professional | | $3,240.00 | $4,500.00 | $5,436.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,780.00 / $5,760.00 / $9,900.00
| Facility | | $3,780.00 | $5,760.00 | $9,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.60 / $7,005.96 / $8,370.81
| Professional | | $3,981.60 | $7,005.96 | $8,370.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $1,512.00 / $4,032.00
| Professional | | $1,512.00 | $1,512.00 | $4,032.00 |