- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,500.00 / $6,095.20
| Facility | | $1,200.00 | $4,500.00 | $6,095.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,200.00 / $2,351.40
| Professional | | $1,000.00 | $1,200.00 | $2,351.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.50 / $3,726.77 / $6,902.00
| Facility | | $2,337.50 | $3,726.77 | $6,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,000.00 / $7,931.26
| Professional | | $1,200.00 | $2,000.00 | $7,931.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,179.22 / $4,546.28 / $7,948.05
| Facility | | $3,179.22 | $4,546.28 | $7,948.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.46 / $560.46 / $560.46
| Professional | | $560.46 | $560.46 | $560.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.30 / $1,560.00 / $4,550.00
| Facility | | $590.30 | $1,560.00 | $4,550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.01 / $2,109.94 / $5,213.52
| Professional | | $1,200.01 | $2,109.94 | $5,213.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,885.89 / $2,885.89 / $3,395.17
| Professional | | $2,885.89 | $2,885.89 | $3,395.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $6,193.80
| Professional | | $2,000.00 | $2,000.00 | $6,193.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.16 / $974.16 / $974.16
| Facility | | $974.16 | $974.16 | $974.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,480.00 / $9,500.00 / $9,500.00
| Facility | | $3,480.00 | $9,500.00 | $9,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $10,000.00
| Professional | | $1,200.00 | $1,200.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $3,572.12
| Professional | | $1,200.00 | $1,200.00 | $3,572.12 |