- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.19 / $657.19 / $9,227.40
| Facility | | $657.19 | $657.19 | $9,227.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.76 / $5,160.84 / $5,160.84
| Professional | | $593.76 | $5,160.84 | $5,160.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.91 / $3,467.91 / $3,467.91
| Professional | | $3,467.91 | $3,467.91 | $3,467.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,495.87 / $3,495.87 / $3,495.87
| Facility | | $3,495.87 | $3,495.87 | $3,495.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,495.87 / $3,495.87 / $3,495.87
| Facility | | $3,495.87 | $3,495.87 | $3,495.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.91 / $3,467.91 / $2,250,000.00
| Professional | | $3,467.91 | $3,467.91 | $2,250,000.00 |