- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.64 / $5,601.89 / $15,537.60
| Facility | | $2,353.64 | $5,601.89 | $15,537.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,500.00 / $2,500.00
| Professional | | $1,500.00 | $2,500.00 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.78 / $3,002.09 / $3,002.09
| Professional | | $2,551.78 | $3,002.09 | $3,002.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,999.80 / $6,889.43 / $13,375.69
| Facility | | $1,999.80 | $6,889.43 | $13,375.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.11 / $3,656.78 / $4,381.22
| Professional | | $1,591.11 | $3,656.78 | $4,381.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,803.34 / $14,259.93 / $14,259.93
| Facility | | $4,803.34 | $14,259.93 | $14,259.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,010.45 / $15,010.45 / $22,515.68
| Professional | | $15,010.45 | $15,010.45 | $22,515.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.27 / $3,002.09 / $4,503.14
| Facility | | $1,831.27 | $3,002.09 | $4,503.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,851.99 / $3,002.09 / $3,752.61
| Professional | | $2,851.99 | $3,002.09 | $3,752.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,951.36 / $3,752.61 / $10,507.32
| Professional | | $1,951.36 | $3,752.61 | $10,507.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,099.78 / $6,889.43 / $15,913.94
| Facility | | $2,099.78 | $6,889.43 | $15,913.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,401.67 / $3,632.53 / $5,253.66
| Professional | | $2,401.67 | $3,632.53 | $5,253.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,260.88 / $2,143.48
| Professional | | $1,260.88 | $1,260.88 | $2,143.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.00 / $1,440.00 / $3,002.09
| Professional | | $1,440.00 | $1,440.00 | $3,002.09 |