- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.50 / $1,332.12 / $1,332.12
| Facility | | $26.50 | $1,332.12 | $1,332.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.73 / $134.38 / $200.09
| Professional | | $90.73 | $134.38 | $200.09 |
- 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
- $202.93 / $266.51 / $266.51
| Professional | | $202.93 | $266.51 | $266.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.81 / $175.81 / $266.51
| Facility | | $175.81 | $175.81 | $266.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.34 / $128.34 / $233.36
| Professional | | $128.34 | $128.34 | $233.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.19 / $266.51 / $506.37
| Professional | | $245.19 | $266.51 | $506.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.51 / $82.51 / $1,231.76
| Facility | | $82.51 | $82.51 | $1,231.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.96 / $186.56 / $226.54
| Professional | | $179.96 | $186.56 | $226.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.50 / $1,332.12 / $1,332.12
| Facility | | $26.50 | $1,332.12 | $1,332.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.41 / $131.00 / $202.93
| Professional | | $88.41 | $131.00 | $202.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.10 / $115.70 / $525.10
| Professional | | $88.10 | $115.70 | $525.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.81 / $175.81 / $266.51
| Facility | | $175.81 | $175.81 | $266.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.34 / $128.34 / $351.75
| Professional | | $128.34 | $128.34 | $351.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.30 / $253.66 / $253.66
| Facility | | $184.30 | $253.66 | $253.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.30 / $253.66 / $288.91
| Professional | | $184.30 | $253.66 | $288.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.80 / $133.18 / $240.34
| Professional | | $110.80 | $133.18 | $240.34 |