- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,850.00 / $12,523.50 / $16,594.20
| Facility | | $3,850.00 | $12,523.50 | $16,594.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,616.25 / $3,850.00 / $4,950.00
| Professional | | $3,616.25 | $3,850.00 | $4,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,063.95 / $6,289.78 / $17,220.50
| Facility | | $4,063.95 | $6,289.78 | $17,220.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,300.00 / $5,500.00 / $21,810.97
| Professional | | $3,300.00 | $5,500.00 | $21,810.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,500.00 / $7,865.00 / $14,751.00
| Facility | | $5,500.00 | $7,865.00 | $14,751.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,170.00 / $5,170.00 / $5,170.00
| Professional | | $5,170.00 | $5,170.00 | $5,170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,538.54 / $4,247.10 / $12,558.00
| Facility | | $3,538.54 | $4,247.10 | $12,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,917.67 / $5,299.09 / $10,623.57
| Professional | | $2,917.67 | $5,299.09 | $10,623.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $5,733.00 / $30,261.00
| Facility | | $83.43 | $5,733.00 | $30,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,856.75 / $7,856.75 / $9,243.23
| Professional | | $7,856.75 | $7,856.75 | $9,243.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,445.00 / $5,445.00 / $10,890.00
| Professional | | $5,445.00 | $5,445.00 | $10,890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,474.29 / $25,863.75 / $25,863.75
| Facility | | $9,474.29 | $25,863.75 | $25,863.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,300.00 / $3,300.00 / $27,116.10
| Professional | | $3,300.00 | $3,300.00 | $27,116.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,267.00 / $3,300.00 / $10,483.39
| Professional | | $3,267.00 | $3,300.00 | $10,483.39 |