- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.97 / $278.04 / $278.04
| Facility | | $247.97 | $278.04 | $278.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.66 / $256.42 / $287.68
| Professional | | $201.66 | $256.42 | $287.68 |
- 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
- $272.30 / $282.58 / $282.58
| Professional | | $272.30 | $282.58 | $282.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.04 / $278.04 / $278.04
| Facility | | $278.04 | $278.04 | $278.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.00 / $256.42 / $300.44
| Professional | | $225.00 | $256.42 | $300.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.50 / $267.50 / $305.39
| Professional | | $267.50 | $267.50 | $305.39 |