- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.50 / $1,424.50 / $1,424.50
| Facility | | $1,424.50 | $1,424.50 | $1,424.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.56 / $1,424.50 / $1,709.40
| Professional | | $1,066.56 | $1,424.50 | $1,709.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.89 / $2,186.63 / $9,950.49
| Facility | | $206.89 | $2,186.63 | $9,950.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.47 / $1,889.46 / $2,206.82
| Professional | | $993.47 | $1,889.46 | $2,206.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.79 / $229.73 / $296.04
| Facility | | $193.79 | $229.73 | $296.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,255.14 / $3,526.26 / $3,526.26
| Professional | | $2,255.14 | $3,526.26 | $3,526.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.47 / $1,682.47 / $1,682.47
| Facility | | $1,682.47 | $1,682.47 | $1,682.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.35 / $2,310.00 / $2,887.50
| Professional | | $172.35 | $2,310.00 | $2,887.50 |
- 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
- $2,019.03 / $2,019.03 / $2,019.03
| Professional | | $2,019.03 | $2,019.03 | $2,019.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $9,950.49 / $9,950.49
| Facility | | $100.00 | $9,950.49 | $9,950.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.71 / $1,183.23 / $2,206.82
| Professional | | $913.71 | $1,183.23 | $2,206.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.16 / $910.68 / $1,322.78
| Facility | | $93.16 | $910.68 | $1,322.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.42 / $1,539.02 / $2,482.67
| Professional | | $914.42 | $1,539.02 | $2,482.67 |