- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.76 / $255.38 / $10,180.81
| Facility | | $227.76 | $255.38 | $10,180.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.72 / $227.76 / $279.93
| Professional | | $169.72 | $227.76 | $279.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.18 / $180.75 / $180.75
| Professional | | $174.18 | $180.75 | $180.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.38 / $255.38 / $10,180.81
| Facility | | $255.38 | $255.38 | $10,180.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.72 / $227.76 / $277.38
| Professional | | $169.72 | $227.76 | $277.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.60 / $206.60 / $279.60
| Professional | | $206.60 | $206.60 | $279.60 |