- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.70 / $7,109.70 / $12,792.00
| Facility | | $1,649.70 | $7,109.70 | $12,792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.65 / $1,649.70 / $1,702.35
| Professional | | $1,105.65 | $1,649.70 | $1,702.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.50 / $3,120.00 / $6,825.00
| Facility | | $2,047.50 | $3,120.00 | $6,825.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.75 / $3,647.25 / $14,625.00
| Professional | | $1,842.75 | $3,647.25 | $14,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,028.00 / $4,145.10 / $5,035.14
| Facility | | $2,028.00 | $4,145.10 | $5,035.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $1,950.00 / $4,875.00
| Facility | | $1,755.00 | $1,950.00 | $4,875.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.00 / $1,950.00 / $4,875.00
| Professional | | $1,755.00 | $1,950.00 | $4,875.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $50.00 / $75.00
| Professional | | $45.00 | $50.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $2,730.00
| Facility | | $1,950.00 | $1,950.00 | $2,730.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $3,412.50 / $5,850.00
| Facility | | $1,950.00 | $3,412.50 | $5,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,281.50 / $2,769.00
| Professional | | $1,755.00 | $2,281.50 | $2,769.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.50 / $3,120.00 / $5,362.50
| Facility | | $2,047.50 | $3,120.00 | $5,362.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,156.69 / $3,429.02 / $4,449.14
| Professional | | $2,156.69 | $3,429.02 | $4,449.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $737.10 / $1,965.60
| Professional | | $737.10 | $737.10 | $1,965.60 |