- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.50 / $137.03 / $137.03
| Facility | | $130.50 | $137.03 | $137.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.01 / $141.06 / $170.17
| Professional | | $115.01 | $141.06 | $170.17 |
- 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
- $18.25 / $18.64 / $25.89
| Professional | | $18.25 | $18.64 | $25.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $147.10 / $234.66
| Facility | | $64.00 | $147.10 | $234.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.38 / $125.04 / $125.04
| Professional | | $107.38 | $125.04 | $125.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.69 / $20.69 / $20.69
| Professional | | $20.69 | $20.69 | $20.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.63 / $139.63 / $139.63
| Professional | | $139.63 | $139.63 | $139.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.03 / $137.03 / $137.03
| Facility | | $137.03 | $137.03 | $137.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.84 / $137.03 / $178.56
| Professional | | $115.84 | $137.03 | $178.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $147.10 / $234.66
| Facility | | $64.00 | $147.10 | $234.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.38 / $125.04 / $147.10
| Professional | | $107.38 | $125.04 | $147.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.00 / $237.00 / $237.00
| Facility | | $237.00 | $237.00 | $237.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.00 / $237.00 / $243.10
| Professional | | $237.00 | $237.00 | $243.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $17.26 / $110.29
| Professional | | $11.78 | $17.26 | $110.29 |