- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,868.00 / $8,374.56 / $23,469.80
| Facility | | $2,868.00 | $8,374.56 | $23,469.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,676.80 / $3,154.80 / $4,063.00
| Professional | | $2,676.80 | $3,154.80 | $4,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,302.00 / $12,189.00 / $24,712.60
| Facility | | $4,302.00 | $12,189.00 | $24,712.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,080.40 / $11,218.44 / $25,339.45
| Facility | | $3,080.40 | $11,218.44 | $25,339.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,533.40 / $5,822.04 / $6,975.46
| Professional | | $2,533.40 | $5,822.04 | $6,975.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,648.00 / $22,705.00 / $22,705.00
| Facility | | $7,648.00 | $22,705.00 | $22,705.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,900.00 / $23,900.00 / $35,850.00
| Professional | | $23,900.00 | $23,900.00 | $35,850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.80 / $4,780.00 / $7,170.00
| Facility | | $2,915.80 | $4,780.00 | $7,170.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,541.00 / $4,780.00 / $5,975.00
| Professional | | $4,541.00 | $4,780.00 | $5,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,107.00 / $5,975.00 / $16,730.00
| Professional | | $3,107.00 | $5,975.00 | $16,730.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,200.91 / $4,780.00 / $14,439.90
| Facility | | $3,200.91 | $4,780.00 | $14,439.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,824.00 / $5,736.00 / $8,365.00
| Professional | | $3,824.00 | $5,736.00 | $8,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,780.00 / $4,780.00 / $5,975.00
| Facility | | $4,780.00 | $4,780.00 | $5,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.60 / $2,007.60 / $3,059.20
| Professional | | $2,007.60 | $2,007.60 | $3,059.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,476.04 / $3,824.00 / $4,780.00
| Professional | | $2,476.04 | $3,824.00 | $4,780.00 |