- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.46 / $991.87 / $991.87
| Professional | | $135.46 | $991.87 | $991.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,000.00 / $81,499.99 / $94,999.99
| Facility | | $47,000.00 | $81,499.99 | $94,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.70 / $347.70 / $347.70
| Professional | | $347.70 | $347.70 | $347.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.98 / $373.84 / $373.84
| Facility | | $212.98 | $373.84 | $373.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.98 / $373.84 / $373.84
| Professional | | $212.98 | $373.84 | $373.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.42 / $356.04 / $373.84
| Facility | | $175.42 | $356.04 | $373.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.98 / $280.58 / $374.12
| Professional | | $212.98 | $280.58 | $374.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.87 / $156.97 / $240.21
| Professional | | $141.87 | $156.97 | $240.21 |