- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $79,432.82
| Professional | | $371.54 | $371.54 | $79,432.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $91,201.08
| Facility | | $354.81 | $446.68 | $91,201.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $398.11
| Professional | | $371.54 | $371.54 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $354.81 / $1,000.00
| Facility | | $331.13 | $354.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $354.81 / $1,000.00
| Professional | | $331.13 | $354.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $371.54 / $524.81
| Professional | | $79.43 | $371.54 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |