- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.38 / $134.38 / $134.38
| Facility | | $134.38 | $134.38 | $134.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.73 / $134.38 / $195.68
| Professional | | $90.73 | $134.38 | $195.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.86 / $616.16 / $1,687.87
| Facility | | $183.86 | $616.16 | $1,687.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $210.87 / $300.36
| Professional | | $120.72 | $210.87 | $300.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.45 / $397.17 / $511.48
| Facility | | $326.45 | $397.17 | $511.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $297.25 / $394.37
| Professional | | $208.00 | $297.25 | $394.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.81 / $177.91 / $215.62
| Facility | | $175.81 | $177.91 | $215.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.34 / $175.81 / $312.11
| Professional | | $128.34 | $175.81 | $312.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.02 / $249.02 / $261.47
| Professional | | $249.02 | $249.02 | $261.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.16 / $142.16 / $165.31
| Facility | | $142.16 | $142.16 | $165.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.31 / $165.31 / $165.31
| Professional | | $165.31 | $165.31 | $165.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.16 / $1,687.87 / $1,687.87
| Facility | | $616.16 | $1,687.87 | $1,687.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.80 / $153.44 / $300.36
| Professional | | $110.80 | $153.44 | $300.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.69 / $158.15 / $266.51
| Professional | | $112.69 | $158.15 | $266.51 |