- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,250.00 / $6,968.31 / $13,825.00
| Facility | | $4,250.00 | $6,968.31 | $13,825.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,700.00 / $4,275.00 / $5,000.00
| Professional | | $3,700.00 | $4,275.00 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,626.75 / $5,325.00 / $16,150.00
| Facility | | $4,626.75 | $5,325.00 | $16,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.70 / $1,716.00 / $3,216.76
| Facility | | $657.70 | $1,716.00 | $3,216.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,850.00 / $7,000.00 / $8,850.00
| Facility | | $5,850.00 | $7,000.00 | $8,850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $6,600.00 / $44,850.00
| Facility | | $59.40 | $6,600.00 | $44,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,000.00 / $3,000.00 / $4,250.00
| Professional | | $3,000.00 | $3,000.00 | $4,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,000.00 / $5,000.00 / $7,600.00
| Professional | | $5,000.00 | $5,000.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,250.00 / $5,000.00 / $5,000.00
| Professional | | $4,250.00 | $5,000.00 | $5,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,050.00 / $5,600.00
| Professional | | $2,000.00 | $2,050.00 | $5,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,275.00 / $3,250.00 / $8,126.63
| Professional | | $2,275.00 | $3,250.00 | $8,126.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,849.62 / $8,125.00 / $15,581.00
| Facility | | $3,849.62 | $8,125.00 | $15,581.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,000.00 / $6,089.96 / $7,296.46
| Professional | | $6,000.00 | $6,089.96 | $7,296.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $4,500.00 / $4,500.00
| Facility | | $4,500.00 | $4,500.00 | $4,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $3,000.00 / $5,500.00
| Professional | | $2,100.00 | $3,000.00 | $5,500.00 |