- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.80 / $341.60 / $2,887.10
| Facility | | $170.80 | $341.60 | $2,887.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.27 / $45.16 / $64.14
| Professional | | $34.27 | $45.16 | $64.14 |
- 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
- $53.38 / $55.40 / $55.40
| Professional | | $53.38 | $55.40 | $55.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.23 / $68.23 / $68.23
| Facility | | $68.23 | $68.23 | $68.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.31 / $50.31 / $50.31
| Professional | | $50.31 | $50.31 | $50.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.12 / $168.16 / $828.90
| Facility | | $58.12 | $168.16 | $828.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.80 / $594.05 / $4,627.39
| Facility | | $170.80 | $594.05 | $4,627.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.27 / $44.39 / $64.14
| Professional | | $34.27 | $44.39 | $64.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.30 / $83.30 / $83.30
| Professional | | $83.30 | $83.30 | $83.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.23 / $68.23 / $68.23
| Facility | | $68.23 | $68.23 | $68.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.31 / $50.31 / $50.31
| Professional | | $50.31 | $50.31 | $50.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.79 / $93.79 / $93.79
| Facility | | $93.79 | $93.79 | $93.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.79 / $93.79 / $93.79
| Professional | | $93.79 | $93.79 | $93.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.81 / $68.06 / $122.17
| Professional | | $50.81 | $68.06 | $122.17 |