- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.44 / $676.07 / $1,955.82
| Facility | | $369.44 | $676.07 | $1,955.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.43 / $369.44 / $430.40
| Professional | | $336.43 | $369.44 | $430.40 |
- 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
- $278.85 / $278.85 / $278.85
| Professional | | $278.85 | $278.85 | $278.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.78 / $160.59 / $419.76
| Facility | | $105.78 | $160.59 | $419.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.50 / $168.50 / $210.63
| Professional | | $168.50 | $168.50 | $210.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.45 / $738.45 / $738.45
| Facility | | $738.45 | $738.45 | $738.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.60 / $727.80 / $1,955.82
| Facility | | $405.60 | $727.80 | $1,955.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.43 / $369.44 / $499.51
| Professional | | $336.43 | $369.44 | $499.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.78 / $210.43 / $431.80
| Facility | | $105.78 | $210.43 | $431.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.50 / $168.50 / $210.63
| Professional | | $168.50 | $168.50 | $210.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.24 / $501.24 / $501.24
| Facility | | $501.24 | $501.24 | $501.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.24 / $501.24 / $501.24
| Professional | | $501.24 | $501.24 | $501.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.37 / $18.37 / $18.37
| Facility | | $18.37 | $18.37 | $18.37 |