- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.00 / $12,250.00 / $14,637.90
| Facility | | $2,975.00 | $12,250.00 | $14,637.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,590.00 / $2,835.00 / $2,975.00
| Professional | | $2,590.00 | $2,835.00 | $2,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,730.00 / $2,730.00 / $2,730.00
| Professional | | $2,730.00 | $2,730.00 | $2,730.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.25 / $4,660.79 / $11,614.71
| Facility | | $2,343.25 | $4,660.79 | $11,614.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,870.00 / $16,870.00 / $16,870.00
| Professional | | $16,870.00 | $16,870.00 | $16,870.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,675.00 / $4,725.00 / $8,645.00
| Professional | | $3,675.00 | $4,725.00 | $8,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,605.00 / $10,412.50 / $14,637.90
| Facility | | $3,605.00 | $10,412.50 | $14,637.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,590.00 / $2,975.00 / $14,455.00
| Professional | | $2,590.00 | $2,975.00 | $14,455.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,180.00 / $5,250.00 / $7,000.00
| Professional | | $5,180.00 | $5,250.00 | $7,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,406.62 / $4,660.79 / $11,614.71
| Facility | | $3,406.62 | $4,660.79 | $11,614.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,870.00 / $16,870.00 / $16,870.00
| Professional | | $16,870.00 | $16,870.00 | $16,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,850.00
| Facility | | $3,500.00 | $3,500.00 | $3,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,850.00
| Professional | | $3,500.00 | $3,500.00 | $3,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.00 / $2,100.00 / $4,673.20
| Professional | | $1,470.00 | $2,100.00 | $4,673.20 |