- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,420.00 / $11,210.40 / $23,616.00
| Facility | | $3,420.00 | $11,210.40 | $23,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,268.00 / $3,384.00 / $3,492.00
| Professional | | $2,268.00 | $3,384.00 | $3,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,780.00 / $5,760.00 / $12,600.00
| Facility | | $3,780.00 | $5,760.00 | $12,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,240.00 / $8,817.09 / $27,000.00
| Professional | | $3,240.00 | $8,817.09 | $27,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,744.00 / $7,652.50 / $9,295.65
| Facility | | $3,744.00 | $7,652.50 | $9,295.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,240.00 / $3,600.00 / $9,000.00
| Facility | | $3,240.00 | $3,600.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,240.00 / $3,600.00 / $9,000.00
| Professional | | $3,240.00 | $3,600.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.00 / $3,600.00 / $5,040.00
| Facility | | $3,600.00 | $3,600.00 | $5,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.00 / $6,264.00 / $10,800.00
| Facility | | $3,600.00 | $6,264.00 | $10,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,240.00 / $4,500.00 / $5,436.00
| Professional | | $3,240.00 | $4,500.00 | $5,436.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,780.00 / $5,760.00 / $9,900.00
| Facility | | $3,780.00 | $5,760.00 | $9,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.60 / $7,034.94 / $8,817.09
| Professional | | $3,981.60 | $7,034.94 | $8,817.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,512.00 / $1,512.00 / $4,032.00
| Professional | | $1,512.00 | $1,512.00 | $4,032.00 |