- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $12,600.00 / $15,056.10
| Facility | | $3,060.00 | $12,600.00 | $15,056.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,160.00 / $2,916.00 / $3,060.00
| Professional | | $2,160.00 | $2,916.00 | $3,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,808.00 / $2,808.00 / $2,808.00
| Professional | | $2,808.00 | $2,808.00 | $2,808.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,410.19 / $4,680.00 / $11,946.12
| Facility | | $2,410.19 | $4,680.00 | $11,946.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,352.00 / $17,352.00 / $17,352.00
| Professional | | $17,352.00 | $17,352.00 | $17,352.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,780.00 / $4,860.00 / $8,892.00
| Professional | | $3,780.00 | $4,860.00 | $8,892.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,008.60 / $12,422.20 / $15,056.10
| Facility | | $4,008.60 | $12,422.20 | $15,056.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,362.67 / $3,060.00 / $14,868.00
| Professional | | $2,362.67 | $3,060.00 | $14,868.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,328.00 / $5,400.00 / $7,200.00
| Professional | | $5,328.00 | $5,400.00 | $7,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,410.19 / $4,680.00 / $11,946.12
| Facility | | $2,410.19 | $4,680.00 | $11,946.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,352.00 / $17,352.00 / $17,352.00
| Professional | | $17,352.00 | $17,352.00 | $17,352.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.00 / $3,600.00 / $3,600.00
| Facility | | $3,600.00 | $3,600.00 | $3,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,600.00 / $3,600.00 / $3,600.00
| Professional | | $3,600.00 | $3,600.00 | $3,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $2,160.00 / $5,040.00
| Professional | | $1,512.00 | $2,160.00 | $5,040.00 |