- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,062.50 / $5,104.75 / $9,765.00
| Facility | | $3,062.50 | $5,104.75 | $9,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,870.00 / $3,290.00
| Professional | | $2,450.00 | $2,870.00 | $3,290.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,375.00 / $6,510.00 / $19,356.93
| Facility | | $4,375.00 | $6,510.00 | $19,356.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.50 / $4,346.64 / $13,650.00
| Facility | | $1,137.50 | $4,346.64 | $13,650.00 |
- 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
- 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
- $239.16 / $509.40 / $3,920.17
| Professional | | $239.16 | $509.40 | $3,920.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,975.00 / $3,500.00 / $3,500.00
| Professional | | $2,975.00 | $3,500.00 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,592.50 / $2,275.00 / $5,688.64
| Professional | | $1,592.50 | $2,275.00 | $5,688.64 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $2,694.74 / $5,687.50 / $10,906.18
| Facility | | $2,694.74 | $5,687.50 | $10,906.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,263.10 / $5,107.68
| Professional | | $4,200.00 | $4,263.10 | $5,107.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,325.00 / $3,325.00 / $4,200.00
| Facility | | $3,325.00 | $3,325.00 | $4,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.00 / $2,100.00 / $3,958.50
| Professional | | $1,470.00 | $2,100.00 | $3,958.50 |