- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $147.60 / $147.60
| Facility | | $144.00 | $147.60 | $147.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.00 / $147.60 / $153.00
| Professional | | $144.00 | $147.60 | $153.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.31 / $423.00 / $999.00
| Facility | | $11.31 | $423.00 | $999.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.40 / $185.40 / $185.40
| Professional | | $185.40 | $185.40 | $185.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.00 / $153.00 / $153.00
| Facility | | $153.00 | $153.00 | $153.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.00 / $153.00 / $153.00
| Professional | | $153.00 | $153.00 | $153.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.00 / $360.00 / $675.00
| Facility | | $180.00 | $360.00 | $675.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.00 / $684.00 / $810.00
| Professional | | $684.00 | $684.00 | $810.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.88 / $180.00 / $312.91
| Facility | | $146.88 | $180.00 | $312.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.60 / $180.00 / $312.91
| Facility | | $147.60 | $180.00 | $312.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.00 / $153.00 / $153.00
| Professional | | $153.00 | $153.00 | $153.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.00 / $297.00 / $297.00
| Facility | | $297.00 | $297.00 | $297.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.00 / $180.00 / $182.34
| Professional | | $180.00 | $180.00 | $182.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.00 / $135.00 / $182.25
| Professional | | $135.00 | $135.00 | $182.25 |