- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,835.00 / $4,582.98 / $9,329.56
| Facility | | $2,835.00 | $4,582.98 | $9,329.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,793.73 / $2,625.00 / $2,975.00
| Professional | | $1,793.73 | $2,625.00 | $2,975.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.87 / $5,767.12 / $15,269.45
| Facility | | $819.87 | $5,767.12 | $15,269.45 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $4,095.00 / $4,900.00 / $6,195.00
| Facility | | $4,095.00 | $4,900.00 | $6,195.00 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,500.00
| Professional | | $3,500.00 | $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
- $239.16 / $507.01 / $3,237.50
| Professional | | $239.16 | $507.01 | $3,237.50 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $2,501.62 / $5,428.96 / $10,742.18
| Facility | | $2,501.62 | $5,428.96 | $10,742.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,263.10 / $4,263.10 / $5,107.68
| Professional | | $4,263.10 | $4,263.10 | $5,107.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,150.00 / $3,150.00 / $3,150.00
| Facility | | $3,150.00 | $3,150.00 | $3,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.00 / $2,100.00 / $4,025.00
| Professional | | $1,470.00 | $2,100.00 | $4,025.00 |