- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,720.00 / $2,720.00 / $7,920.91
| Facility | | $2,720.00 | $2,720.00 | $7,920.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,400.00 / $2,720.00 / $2,720.00
| Professional | | $2,400.00 | $2,720.00 | $2,720.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,153.60 / $15,584.00 / $19,680.00
| Facility | | $12,153.60 | $15,584.00 | $19,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $7.49 / $12.50
| Professional | | $7.49 | $7.49 | $12.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,560.00 / $2,560.00 / $4,992.00
| Professional | | $2,560.00 | $2,560.00 | $4,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.00 / $7,053.95 / $16,393.68
| Facility | | $2,080.00 | $7,053.95 | $16,393.68 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $3,200.00 / $3,840.00 / $4,736.00
| Professional | | $3,200.00 | $3,840.00 | $4,736.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,200.00 / $5,440.00
| Facility | | $2,400.00 | $3,200.00 | $5,440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,776.00 / $5,600.00 / $7,680.00
| Professional | | $3,776.00 | $5,600.00 | $7,680.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,390.40 / $3,680.00 / $5,941.12
| Facility | | $2,390.40 | $3,680.00 | $5,941.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,390.40 / $3,680.00 / $5,941.12
| Professional | | $2,390.40 | $3,680.00 | $5,941.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.00 / $1,600.00 / $3,680.00
| Professional | | $1,344.00 | $1,600.00 | $3,680.00 |