- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.21 / $8,625.00 / $11,428.50
| Facility | | $2,044.21 | $8,625.00 | $11,428.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,920.10 / $2,161.02 / $4,408.88
| Professional | | $1,920.10 | $2,161.02 | $4,408.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,770.72 / $3,186.33 / $9,004.84
| Facility | | $2,770.72 | $3,186.33 | $9,004.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.18 / $2,250.00 / $18,750.00
| Professional | | $1,752.18 | $2,250.00 | $18,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,352.37 / $8,225.24 / $14,900.80
| Facility | | $5,352.37 | $8,225.24 | $14,900.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,450.00 / $3,450.00 / $3,450.00
| Professional | | $3,450.00 | $3,450.00 | $3,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.58 / $2,925.00 / $8,531.25
| Facility | | $2,059.58 | $2,925.00 | $8,531.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,989.35 / $3,599.96 / $9,775.69
| Professional | | $1,989.35 | $3,599.96 | $9,775.69 |
- 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
- $5,411.00 / $5,411.00 / $6,365.89
| Professional | | $5,411.00 | $5,411.00 | $6,365.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,750.00 / $3,750.00 / $11,613.38
| Professional | | $3,750.00 | $3,750.00 | $11,613.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,525.00 / $17,812.50 / $17,812.50
| Facility | | $6,525.00 | $17,812.50 | $17,812.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.18 / $2,250.00 / $18,750.00
| Professional | | $1,752.18 | $2,250.00 | $18,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.18 / $2,250.00 / $6,328.32
| Professional | | $1,752.18 | $2,250.00 | $6,328.32 |