- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.46 / $400.55 / $400.55
| Facility | | $57.46 | $400.55 | $400.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.36 / $60.84 / $88.64
| Professional | | $50.36 | $60.84 | $88.64 |
- 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
- $97.98 / $128.66 / $128.66
| Professional | | $97.98 | $128.66 | $128.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.66 / $104.66 / $128.66
| Facility | | $104.66 | $104.66 | $128.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.96 / $88.96 / $112.67
| Professional | | $88.96 | $88.96 | $112.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.00 / $128.66 / $244.47
| Professional | | $110.00 | $128.66 | $244.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.28 / $269.13 / $594.69
| Facility | | $213.28 | $269.13 | $594.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.24 / $400.55 / $549.80
| Facility | | $242.24 | $400.55 | $549.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.36 / $63.10 / $237.91
| Professional | | $50.36 | $63.10 | $237.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.60 / $183.50 / $253.50
| Professional | | $159.60 | $183.50 | $253.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.66 / $104.66 / $128.66
| Facility | | $104.66 | $104.66 | $128.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.96 / $88.96 / $153.00
| Professional | | $88.96 | $88.96 | $153.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.94 / $122.47 / $122.47
| Facility | | $89.94 | $122.47 | $122.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.94 / $122.47 / $125.49
| Professional | | $89.94 | $122.47 | $125.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.19 / $77.20 / $116.05
| Professional | | $60.19 | $77.20 | $116.05 |