- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.00 / $8,280.00 / $10,971.40
| Facility | | $2,520.00 | $8,280.00 | $10,971.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,367.00 / $2,520.00 / $3,240.00
| Professional | | $2,367.00 | $2,520.00 | $3,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.04 / $4,116.93 / $11,271.60
| Facility | | $2,660.04 | $4,116.93 | $11,271.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,160.00 / $3,600.00 / $14,276.27
| Professional | | $2,160.00 | $3,600.00 | $14,276.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.00 / $5,148.00 / $9,655.20
| Facility | | $3,600.00 | $5,148.00 | $9,655.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,384.00 / $3,384.00 / $3,384.00
| Professional | | $3,384.00 | $3,384.00 | $3,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,245.23 / $2,574.00 / $8,190.00
| Facility | | $2,245.23 | $2,574.00 | $8,190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,909.76 / $3,455.84 / $7,023.69
| Professional | | $1,909.76 | $3,455.84 | $7,023.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,585.00 / $19,807.20
| Facility | | $83.43 | $5,585.00 | $19,807.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,194.42 / $5,194.42 / $6,111.09
| Professional | | $5,194.42 | $5,194.42 | $6,111.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,600.00 / $3,600.00 / $10,044.00
| Professional | | $3,600.00 | $3,600.00 | $10,044.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,264.00 / $17,100.00 / $17,100.00
| Facility | | $6,264.00 | $17,100.00 | $17,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,160.00 / $2,160.00 / $17,928.00
| Professional | | $2,160.00 | $2,160.00 | $17,928.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,160.00 / $2,160.00 / $6,861.85
| Professional | | $2,160.00 | $2,160.00 | $6,861.85 |