- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $144.00 / $144.00
| Facility | | $144.00 | $144.00 | $144.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.00 / $144.00 / $153.00
| Professional | | $144.00 | $144.00 | $153.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.00 / $153.00 / $171.00
| Professional | | $135.00 | $153.00 | $171.00 |
- 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
- $144.00 / $145.80 / $214.56
| Facility | | $144.00 | $145.80 | $214.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $145.80 / $216.00
| Facility | | $144.00 | $145.80 | $216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.00 / $180.00 / $378.00
| Professional | | $180.00 | $180.00 | $378.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $65.00 / $552.45
| Professional | | $50.00 | $65.00 | $552.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $144.00 / $214.56
| Facility | | $144.00 | $144.00 | $214.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,900.00 / $5,900.00 / $5,900.00
| Professional | | $5,900.00 | $5,900.00 | $5,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.00 / $180.00 / $675.00
| Facility | | $153.00 | $180.00 | $675.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.00 / $190.80 / $684.00
| Professional | | $153.00 | $190.80 | $684.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.00 / $387.00 / $421.20
| Facility | | $387.00 | $387.00 | $421.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.00 / $180.00 / $246.46
| Professional | | $180.00 | $180.00 | $246.46 |