- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.94 / $36.94 / $142.96
| Facility | | $36.94 | $36.94 | $142.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.13 / $43.22 / $187.94
| Professional | | $35.13 | $43.22 | $187.94 |
- 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
- $68.34 / $89.75 / $89.75
| Professional | | $68.34 | $89.75 | $89.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.54 / $61.54 / $89.75
| Facility | | $61.54 | $61.54 | $89.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.92 / $44.92 / $107.57
| Professional | | $44.92 | $44.92 | $107.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.57 / $89.75 / $170.53
| Professional | | $82.57 | $89.75 | $170.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.94 / $36.94 / $142.96
| Facility | | $36.94 | $36.94 | $142.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.13 / $46.37 / $258.97
| Professional | | $35.13 | $46.37 | $258.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.30 / $52.90 / $176.80
| Professional | | $48.30 | $52.90 | $176.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.54 / $61.54 / $89.75
| Facility | | $61.54 | $61.54 | $89.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.92 / $44.92 / $128.60
| Professional | | $44.92 | $44.92 | $128.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.17 / $85.43 / $85.43
| Facility | | $64.17 | $85.43 | $85.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.17 / $85.43 / $87.50
| Professional | | $64.17 | $85.43 | $87.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.15 / $44.78 / $80.94
| Professional | | $34.15 | $44.78 | $80.94 |