- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,833.00 / $6,072.30 / $13,923.00
| Facility | | $1,833.00 | $6,072.30 | $13,923.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.50 / $1,833.00 / $1,891.50
| Professional | | $1,228.50 | $1,833.00 | $1,891.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.50 / $3,199.95 / $9,262.50
| Facility | | $2,047.50 | $3,199.95 | $9,262.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.00 / $5,509.45 / $14,625.00
| Professional | | $1,755.00 | $5,509.45 | $14,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,028.00 / $4,145.10 / $5,035.14
| Facility | | $2,028.00 | $4,145.10 | $5,035.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $1,950.00 / $3,315.00
| Facility | | $1,755.00 | $1,950.00 | $3,315.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.00 / $1,950.00 / $4,875.00
| Professional | | $1,755.00 | $1,950.00 | $4,875.00 |
- 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
- $1,950.00 / $1,950.00 / $2,730.00
| Facility | | $1,950.00 | $1,950.00 | $2,730.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $3,412.50 / $5,850.00
| Facility | | $1,950.00 | $3,412.50 | $5,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,437.50 / $2,944.50
| Professional | | $1,755.00 | $2,437.50 | $2,944.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.50 / $3,217.50 / $5,362.50
| Facility | | $2,047.50 | $3,217.50 | $5,362.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,156.69 / $3,810.52 / $4,534.09
| Professional | | $2,156.69 | $3,810.52 | $4,534.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $2,340.00 / $2,340.00
| Facility | | $1,950.00 | $2,340.00 | $2,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.00 / $819.00 / $2,184.00
| Professional | | $819.00 | $819.00 | $2,184.00 |