- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $15,570.00 / $32,800.00
| Facility | | $4,700.00 | $15,570.00 | $32,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,275.00 / $4,700.00 / $5,000.00
| Professional | | $4,275.00 | $4,700.00 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,250.00 / $8,000.00 / $17,500.00
| Facility | | $5,250.00 | $8,000.00 | $17,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,942.93 / $10,394.53 / $37,500.00
| Professional | | $4,942.93 | $10,394.53 | $37,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,200.00 / $10,628.48 / $12,910.63
| Facility | | $5,200.00 | $10,628.48 | $12,910.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $5,000.00 / $25,195.00
| Facility | | $4,500.00 | $5,000.00 | $25,195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,500.00 / $5,000.00 / $12,500.00
| Professional | | $4,500.00 | $5,000.00 | $12,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $5,000.00 / $7,000.00
| Facility | | $5,000.00 | $5,000.00 | $7,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,750.00 / $15,000.00
| Facility | | $5,000.00 | $8,750.00 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,500.00 / $6,250.00 / $7,550.00
| Professional | | $4,500.00 | $6,250.00 | $7,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,250.00 / $8,000.00 / $13,750.00
| Facility | | $5,250.00 | $8,000.00 | $13,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,753.04 / $9,769.29 / $12,246.65
| Professional | | $5,753.04 | $9,769.29 | $12,246.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,100.00 / $5,500.00
| Professional | | $2,100.00 | $2,100.00 | $5,500.00 |