- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.24 / $248.50 / $248.50
| Facility | | $228.24 | $248.50 | $248.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.98 / $228.97 / $278.10
| Professional | | $206.98 | $228.97 | $278.10 |
- 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
- $207.49 / $207.49 / $213.71
| Professional | | $207.49 | $207.49 | $213.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.81 / $65.81 / $324.76
| Professional | | $65.81 | $65.81 | $324.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.75 / $186.75 / $186.75
| Facility | | $186.75 | $186.75 | $186.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.75 / $186.75 / $186.75
| Professional | | $186.75 | $186.75 | $186.75 |
- 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
- $207.49 / $207.49 / $213.71
| Professional | | $207.49 | $207.49 | $213.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $190.82 / $190.82
| Professional | | $10.21 | $190.82 | $190.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.49 / $207.49 / $213.71
| Professional | | $207.49 | $207.49 | $213.71 |