- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,030.00 / $4,969.20 / $9,234.23
| Facility | | $3,030.00 | $4,969.20 | $9,234.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.00 / $2,363.40 / $3,030.00
| Professional | | $2,121.00 | $2,363.40 | $3,030.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,545.10 / $4,242.00 / $5,363.10
| Facility | | $3,545.10 | $4,242.00 | $5,363.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,797.82 / $4,992.68 / $13,218.98
| Facility | | $1,797.82 | $4,992.68 | $13,218.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $3,999.60 / $27,179.10
| Facility | | $59.30 | $3,999.60 | $27,179.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,818.00 / $1,818.00 / $2,575.50
| Professional | | $1,818.00 | $1,818.00 | $2,575.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,500.00 / $3,030.00
| Professional | | $1,500.00 | $1,500.00 | $3,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,030.00 / $3,030.00 / $3,030.00
| Professional | | $3,030.00 | $3,030.00 | $3,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,030.00 / $3,030.00 / $4,605.60
| Professional | | $3,030.00 | $3,030.00 | $4,605.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.65 / $1,969.50 / $4,951.13
| Professional | | $1,378.65 | $1,969.50 | $4,951.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,704.12 / $5,120.70 / $9,089.24
| Facility | | $2,704.12 | $5,120.70 | $9,089.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,636.00 / $3,690.49 / $4,421.62
| Professional | | $3,636.00 | $3,690.49 | $4,421.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,666.50 / $1,666.50 / $3,030.00
| Facility | | $1,666.50 | $1,666.50 | $3,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.59 / $1,818.00 / $3,484.50
| Professional | | $1,272.59 | $1,818.00 | $3,484.50 |