- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.00 / $307.00 / $307.00
| Facility | | $307.00 | $307.00 | $307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.06 / $336.61 / $472.65
| Facility | | $216.06 | $336.61 | $472.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.56 / $156.56 / $156.56
| Professional | | $156.56 | $156.56 | $156.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Professional | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.04 / $678.82 / $1,863.65
| Facility | | $150.04 | $678.82 | $1,863.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $85.00 / $85.00
| Professional | | $85.00 | $85.00 | $85.00 |