- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.06 / $163.24 / $207.32
| Facility | | $60.06 | $163.24 | $207.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.24 / $163.24 / $179.56
| Professional | | $163.24 | $163.24 | $179.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.24 / $182.64 / $8,639.91
| Facility | | $155.24 | $182.64 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.64 / $182.64 / $182.64
| Professional | | $182.64 | $182.64 | $182.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.39 / $179.39 / $179.39
| Facility | | $179.39 | $179.39 | $179.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.39 / $179.39 / $179.39
| Professional | | $179.39 | $179.39 | $179.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.00 / $310.00 / $1,035.66
| Facility | | $310.00 | $310.00 | $1,035.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.06 / $163.24 / $275.88
| Facility | | $60.06 | $163.24 | $275.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.24 / $163.24 / $280.77
| Professional | | $163.24 | $163.24 | $280.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.39 / $179.39 / $179.39
| Facility | | $179.39 | $179.39 | $179.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.39 / $179.39 / $179.39
| Professional | | $179.39 | $179.39 | $179.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.03 / $135.03 / $173.51
| Facility | | $135.03 | $135.03 | $173.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.03 / $135.03 / $173.51
| Professional | | $135.03 | $135.03 | $173.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.98 / $192.05 / $230.46
| Professional | | $164.98 | $192.05 | $230.46 |