- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.13 / $713.75 / $150,955.01
| Facility | | $311.13 | $713.75 | $150,955.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.82 / $311.13 / $311.13
| Professional | | $292.82 | $311.13 | $311.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.57 / $347.73 / $8,459.92
| Facility | | $295.57 | $347.73 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.73 / $347.73 / $347.73
| Professional | | $347.73 | $347.73 | $347.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.13 / $311.13 / $311.13
| Facility | | $311.13 | $311.13 | $311.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.13 / $311.13 / $311.13
| Professional | | $311.13 | $311.13 | $311.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.45 / $311.13 / $311.13
| Professional | | $264.45 | $311.13 | $311.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.16 / $613.16 / $628.14
| Facility | | $613.16 | $613.16 | $628.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.87 / $713.75 / $164,400.00
| Facility | | $356.87 | $713.75 | $164,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.82 / $311.13 / $387.38
| Professional | | $292.82 | $311.13 | $387.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.67 / $687.67 / $744.38
| Professional | | $687.67 | $687.67 | $744.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.13 / $311.13 / $311.13
| Facility | | $311.13 | $311.13 | $311.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.13 / $311.13 / $311.13
| Professional | | $311.13 | $311.13 | $311.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.58 / $303.58 / $333.94
| Facility | | $303.58 | $303.58 | $333.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.58 / $303.58 / $333.94
| Professional | | $303.58 | $303.58 | $333.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.02 / $305.02 / $430.79
| Professional | | $305.02 | $305.02 | $430.79 |