- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.80 / $396.74 / $412.99
| Professional | | $240.80 | $396.74 | $412.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $296.00 / $296.00
| Facility | | $296.00 | $296.00 | $296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.60 / $251.60 / $296.00
| Professional | | $251.60 | $251.60 | $296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99,999.99 / $99,999.99 / $99,999.99
| Facility | | $99,999.99 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99,999.99 / $99,999.99 / $99,999.99
| Professional | | $99,999.99 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.47 / $357.47 / $357.47
| Professional | | $357.47 | $357.47 | $357.47 |