- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,852.10 / $13,781.30 / $15,177.80
| Facility | | $4,852.10 | $13,781.30 | $15,177.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.75 / $2,940.00 / $3,123.75
| Professional | | $1,947.75 | $2,940.00 | $3,123.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,866.50 / $2,866.50 / $2,866.50
| Professional | | $2,866.50 | $2,866.50 | $2,866.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.41 / $4,774.63 / $10,981.08
| Facility | | $2,460.41 | $4,774.63 | $10,981.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,713.50 / $17,713.50 / $17,713.50
| Professional | | $17,713.50 | $17,713.50 | $17,713.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,858.75 / $4,961.25 / $9,077.25
| Professional | | $3,858.75 | $4,961.25 | $9,077.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,655.82 / $15,177.80 / $15,177.80
| Facility | | $5,655.82 | $15,177.80 | $15,177.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,411.90 / $3,123.75 / $15,177.80
| Professional | | $2,411.90 | $3,123.75 | $15,177.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,439.00 / $5,512.50 / $7,350.00
| Professional | | $5,439.00 | $5,512.50 | $7,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,560.73 / $4,643.59 / $12,194.96
| Facility | | $2,560.73 | $4,643.59 | $12,194.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,713.50 / $17,713.50 / $17,713.50
| Professional | | $17,713.50 | $17,713.50 | $17,713.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,675.00 / $3,675.00 / $4,042.50
| Facility | | $3,675.00 | $3,675.00 | $4,042.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,675.00 / $3,675.00 / $4,042.50
| Professional | | $3,675.00 | $3,675.00 | $4,042.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.50 / $2,205.00 / $5,145.00
| Professional | | $1,543.50 | $2,205.00 | $5,145.00 |