- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.00 / $5,606.40 / $15,589.10
| Facility | | $1,920.00 | $5,606.40 | $15,589.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,792.00 / $2,112.00 / $2,560.00
| Professional | | $1,792.00 | $2,112.00 | $2,560.00 |
- 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
- $2,062.19 / $7,510.26 / $16,963.03
| Facility | | $2,062.19 | $7,510.26 | $16,963.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,897.99 / $3,897.99 / $4,670.24
| Professional | | $3,897.99 | $3,897.99 | $4,670.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,120.00 / $15,200.00 / $15,200.00
| Facility | | $5,120.00 | $15,200.00 | $15,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,936.00 / $15,936.00 / $24,000.00
| Professional | | $15,936.00 | $15,936.00 | $24,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.00 / $3,200.00 / $4,768.00
| Facility | | $1,920.00 | $3,200.00 | $4,768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,200.00 / $3,200.00 / $4,000.00
| Professional | | $3,200.00 | $3,200.00 | $4,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,880.00 / $4,000.00 / $7,200.00
| Professional | | $2,880.00 | $4,000.00 | $7,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.00 / $3,200.00 / $9,667.32
| Facility | | $1,920.00 | $3,200.00 | $9,667.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,024.04 / $3,520.00 / $5,600.00
| Professional | | $3,024.04 | $3,520.00 | $5,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.00 / $1,344.00 / $2,048.00
| Professional | | $1,344.00 | $1,344.00 | $2,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,148.40 / $3,200.00
| Professional | | $1,148.40 | $1,148.40 | $3,200.00 |