- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.32 / $304.70 / $304.70
| Facility | | $284.32 | $304.70 | $304.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.49 / $276.69 / $325.26
| Professional | | $259.49 | $276.69 | $325.26 |
- 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
- $258.47 / $258.47 / $266.22
| Professional | | $258.47 | $258.47 | $266.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $22.70 / $358.15
| Professional | | $22.70 | $22.70 | $358.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.86 / $217.86 / $312.82
| Facility | | $217.86 | $217.86 | $312.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.86 / $217.86 / $291.51
| Professional | | $217.86 | $217.86 | $291.51 |
- 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
- $258.47 / $258.47 / $266.22
| Professional | | $258.47 | $258.47 | $266.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.47 / $258.47 / $266.22
| Professional | | $258.47 | $258.47 | $266.22 |