- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.00 / $5,050.50 / $10,666.60
| Facility | | $2,975.00 | $5,050.50 | $10,666.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,975.00 / $3,325.00
| Professional | | $2,450.00 | $2,975.00 | $3,325.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,238.72 / $3,727.50 / $10,581.55
| Facility | | $3,238.72 | $3,727.50 | $10,581.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $4,620.00 / $31,395.00
| Facility | | $59.40 | $4,620.00 | $31,395.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,095.00 / $4,900.00 / $6,195.00
| Facility | | $4,095.00 | $4,900.00 | $6,195.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $8,519.00 / $18,340.00
| Facility | | $3,500.00 | $8,519.00 | $18,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $8,540.00
| Professional | | $3,500.00 | $3,500.00 | $8,540.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $5,320.00
| Professional | | $3,500.00 | $3,500.00 | $5,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $583.58 / $3,683.75
| Professional | | $239.16 | $583.58 | $3,683.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,100.00 / $2,975.00
| Professional | | $2,100.00 | $2,100.00 | $2,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,450.00 / $3,500.00 / $8,798.65
| Professional | | $2,450.00 | $3,500.00 | $8,798.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,321.50 / $6,142.50 / $10,169.25
| Facility | | $3,321.50 | $6,142.50 | $10,169.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $4,263.10 / $5,107.68
| Professional | | $3,500.00 | $4,263.10 | $5,107.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.00 / $1,925.00 / $3,500.00
| Facility | | $1,925.00 | $1,925.00 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.00 / $2,100.00 / $4,025.00
| Professional | | $1,470.00 | $2,100.00 | $4,025.00 |