- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $8,760.00 / $24,550.00
| Facility | | $3,300.00 | $8,760.00 | $24,550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,800.00 / $3,300.00 / $4,750.00
| Professional | | $2,800.00 | $3,300.00 | $4,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,000.00 / $5,000.00 / $5,000.00
| Professional | | $5,000.00 | $5,000.00 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.00 / $3,570.42 / $15,105.37
| Facility | | $3,159.00 | $3,570.42 | $15,105.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,089.96 / $6,089.96 / $7,296.46
| Professional | | $6,089.96 | $6,089.96 | $7,296.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,000.00 / $23,750.00 / $23,750.00
| Facility | | $8,000.00 | $23,750.00 | $23,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,900.00 / $24,900.00 / $37,500.00
| Professional | | $24,900.00 | $24,900.00 | $37,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $5,000.00 / $7,450.00
| Facility | | $3,000.00 | $5,000.00 | $7,450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,000.00 / $5,000.00 / $6,250.00
| Professional | | $5,000.00 | $5,000.00 | $6,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,500.00 / $6,250.00 / $11,250.00
| Professional | | $4,500.00 | $6,250.00 | $11,250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,455.16 / $3,905.15 / $15,105.37
| Facility | | $3,455.16 | $3,905.15 | $15,105.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,725.12 / $5,500.00 / $8,750.00
| Professional | | $4,725.12 | $5,500.00 | $8,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,100.00 / $3,200.00
| Professional | | $2,100.00 | $2,100.00 | $3,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $5,000.00
| Professional | | $2,000.00 | $2,000.00 | $5,000.00 |