- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.54 / $101.03 / $452.25
| Facility | | $98.54 | $101.03 | $452.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.03 / $101.03 / $127.29
| Professional | | $101.03 | $101.03 | $127.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.03 / $101.03 / $101.03
| Facility | | $101.03 | $101.03 | $101.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.54 / $110.74 / $110.74
| Professional | | $98.54 | $110.74 | $110.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.03 / $101.03 / $101.03
| Facility | | $101.03 | $101.03 | $101.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.73 / $101.03 / $101.03
| Professional | | $65.73 | $101.03 | $101.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.61 / $109.61 / $205.08
| Professional | | $109.61 | $109.61 | $205.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.38 / $127.38 / $127.38
| Professional | | $127.38 | $127.38 | $127.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.03 / $101.03 / $101.03
| Professional | | $101.03 | $101.03 | $101.03 |