- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.06 / $2,863.84 / $2,863.84
| Facility | | $211.06 | $2,863.84 | $2,863.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.06 / $246.98 / $478.88
| Professional | | $211.06 | $246.98 | $478.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.50 / $512.84 / $512.84
| Professional | | $390.50 | $512.84 | $512.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.45 / $361.45 / $588.21
| Facility | | $361.45 | $361.45 | $588.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $263.86 / $515.04
| Professional | | $263.86 | $263.86 | $515.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.15 / $588.21 / $1,117.59
| Professional | | $541.15 | $588.21 | $1,117.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.59 / $778.59 / $2,370.23
| Facility | | $778.59 | $778.59 | $2,370.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.99 / $400.66 / $410.28
| Professional | | $358.99 | $400.66 | $410.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.06 / $2,863.84 / $2,863.84
| Facility | | $211.06 | $2,863.84 | $2,863.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.06 / $246.98 / $919.07
| Professional | | $211.06 | $246.98 | $919.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.40 / $246.30 / $1,158.90
| Professional | | $187.40 | $246.30 | $1,158.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.45 / $361.45 / $588.21
| Facility | | $361.45 | $361.45 | $588.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $263.86 / $788.63
| Professional | | $263.86 | $263.86 | $788.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.46 / $488.13 / $488.13
| Facility | | $330.46 | $488.13 | $488.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.46 / $488.13 / $647.40
| Professional | | $330.46 | $488.13 | $647.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.31 / $258.68 / $472.02
| Professional | | $213.31 | $258.68 | $472.02 |