- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.65 / $77.62 / $8,690.18
| Facility | | $55.65 | $77.62 | $8,690.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $55.65 / $66.78
| Professional | | $55.65 | $55.65 | $66.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.03 / $153.65 / $278.25
| Facility | | $44.03 | $153.65 | $278.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $58.43 / $2,122.62
| Professional | | $55.65 | $58.43 | $2,122.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.66 / $68.34 / $132.78
| Facility | | $59.66 | $68.34 | $132.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.97 / $55.65 / $55.65
| Facility | | $51.97 | $55.65 | $55.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $55.65 / $55.65
| Professional | | $55.65 | $55.65 | $55.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.65 / $87.04 / $8,090.00
| Facility | | $55.65 | $87.04 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $55.65 / $55.65
| Professional | | $55.65 | $55.65 | $55.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $55.65 / $64.41
| Professional | | $55.65 | $55.65 | $64.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,431.94 / $7,431.94 / $9,902.83
| Facility | | $7,431.94 | $7,431.94 | $9,902.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $278.25 / $278.25
| Facility | | $75.00 | $278.25 | $278.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $58.99 / $2,122.62
| Professional | | $55.65 | $58.99 | $2,122.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.29 / $32.72 / $59.50
| Facility | | $29.29 | $32.72 | $59.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $58.85 / $72.08
| Professional | | $55.65 | $58.85 | $72.08 |