- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.71 / $248.71 / $248.71
| Facility | | $248.71 | $248.71 | $248.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.29 / $16.29 / $303.83
| Professional | | $16.29 | $16.29 | $303.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $455.58 / $523.80
| Facility | | $100.00 | $455.58 | $523.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.14 / $244.14 / $244.14
| Professional | | $244.14 | $244.14 | $244.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.33 / $281.33 / $281.33
| Professional | | $281.33 | $281.33 | $281.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.05 / $117.05 / $188.80
| Professional | | $117.05 | $117.05 | $188.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.14 / $244.14 / $244.14
| Professional | | $244.14 | $244.14 | $244.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.05 / $117.05 / $117.05
| Professional | | $117.05 | $117.05 | $117.05 |