- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,720.00 / $4,240.00 / $8,736.00
| Facility | | $2,720.00 | $4,240.00 | $8,736.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.00 / $2,624.00 / $2,880.00
| Professional | | $2,240.00 | $2,624.00 | $2,880.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,744.00 / $4,480.00 / $5,664.00
| Facility | | $3,744.00 | $4,480.00 | $5,664.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,825.00 / $15,075.00 / $19,125.00
| Facility | | $12,825.00 | $15,075.00 | $19,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $4,832.00 / $8,800.00
| Facility | | $97.00 | $4,832.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.10 / $4,696.00 / $12,480.00
| Facility | | $1,242.10 | $4,696.00 | $12,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,920.00 / $1,920.00 / $2,720.00
| Professional | | $1,920.00 | $1,920.00 | $2,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,236.59 / $3,392.70
| Professional | | $1,148.40 | $1,236.59 | $3,392.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.00 / $2,080.00 / $5,201.04
| Professional | | $1,456.00 | $2,080.00 | $5,201.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,515.76 / $5,382.00 / $9,821.55
| Facility | | $2,515.76 | $5,382.00 | $9,821.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,840.00 / $3,897.99 / $4,670.24
| Professional | | $3,840.00 | $3,897.99 | $4,670.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,000.00 / $4,000.00 / $4,800.00
| Facility | | $4,000.00 | $4,000.00 | $4,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.00 / $1,920.00 / $3,680.00
| Professional | | $1,344.00 | $1,920.00 | $3,680.00 |