- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.00 / $220.00 / $220.00
| Facility | | $220.00 | $220.00 | $220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.00 / $244.72 / $337.45
| Professional | | $220.00 | $244.72 | $337.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.44 / $941.10 / $3,188.91
| Facility | | $265.44 | $941.10 | $3,188.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.81 / $383.40 / $491.71
| Professional | | $226.81 | $383.40 | $491.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.42 / $650.20 / $837.33
| Facility | | $534.42 | $650.20 | $837.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.70 / $419.22 / $419.22
| Professional | | $329.70 | $419.22 | $419.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.24 / $319.76 / $352.99
| Facility | | $291.24 | $319.76 | $352.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.42 / $233.42 / $583.88
| Professional | | $233.42 | $233.42 | $583.88 |
- 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
- $407.67 / $407.67 / $428.05
| Professional | | $407.67 | $407.67 | $428.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.69 / $292.69 / $292.69
| Facility | | $292.69 | $292.69 | $292.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.26 / $313.26 / $313.26
| Professional | | $313.26 | $313.26 | $313.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.13 / $3,188.91 / $3,188.91
| Facility | | $1,022.13 | $3,188.91 | $3,188.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.54 / $269.14 / $491.71
| Professional | | $193.54 | $269.14 | $491.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.68 / $269.14 / $491.71
| Professional | | $196.68 | $269.14 | $491.71 |