- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $177.83
| Professional | | $77.62 | $112.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $263.03 / $977.24
| Facility | | $229.09 | $263.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $181.97 / $263.03
| Professional | | $95.50 | $181.97 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $446.68
| Facility | | $147.91 | $147.91 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $194.98
| Professional | | $165.96 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $147.91 / $177.83
| Facility | | $120.23 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $147.91
| Professional | | $87.10 | $87.10 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $338.84
| Professional | | $223.87 | $223.87 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $263.03 / $977.24
| Facility | | $229.09 | $263.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $194.98 / $263.03
| Professional | | $95.50 | $194.98 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.15 / $120.23 / $257.04
| Facility | | $0.15 | $120.23 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $134.90 / $223.87
| Professional | | $89.13 | $134.90 | $223.87 |