- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,793.73 / $5,646.66 / $15,157.00
| Facility | | $1,793.73 | $5,646.66 | $15,157.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,793.73 / $1,793.73 / $2,800.00
| Professional | | $1,793.73 | $1,793.73 | $2,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $17,535.00
| Facility | | $244.00 | $614.00 | $17,535.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $272.64 / $435.27
| Professional | | $239.16 | $272.64 | $435.27 |
- 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
- $1,592.50 / $2,275.00 / $5,688.64
| Professional | | $1,592.50 | $2,275.00 | $5,688.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.77 / $4,697.88 / $11,454.63
| Facility | | $2,343.77 | $4,697.88 | $11,454.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,850.00 / $4,725.00
| Professional | | $3,500.00 | $3,850.00 | $4,725.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,150.00 / $4,025.00 / $6,825.00
| Professional | | $3,150.00 | $4,025.00 | $6,825.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,090.00 / $16,625.00 / $16,625.00
| Facility | | $6,090.00 | $16,625.00 | $16,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,430.00 / $17,430.00 / $26,250.00
| Professional | | $17,430.00 | $17,430.00 | $26,250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.77 / $4,595.50 / $10,601.50
| Facility | | $2,343.77 | $4,595.50 | $10,601.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,850.00 / $5,250.00
| Professional | | $3,500.00 | $3,850.00 | $5,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,800.00 / $3,570.00 / $5,950.00
| Professional | | $2,800.00 | $3,570.00 | $5,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.00 / $1,580.99 / $7,334.25
| Professional | | $1,470.00 | $1,580.99 | $7,334.25 |