- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $243.16
| Facility | | $114.43 | $114.43 | $243.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $114.43
| Professional | | $114.43 | $114.43 | $114.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.73 / $139.00 / $395.58
| Facility | | $110.73 | $139.00 | $395.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.31 / $34.31 / $75.94
| Professional | | $34.31 | $34.31 | $75.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.94 / $182.94 / $182.94
| Facility | | $182.94 | $182.94 | $182.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.92 / $131.75 / $164.68
| Professional | | $25.92 | $131.75 | $164.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $138.57
| Professional | | $114.43 | $114.43 | $138.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $185.38
| Facility | | $114.43 | $114.43 | $185.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $114.43
| Professional | | $114.43 | $114.43 | $114.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.65 / $57.18 / $138.19
| Professional | | $47.65 | $57.18 | $138.19 |