- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.26 / $4,904.00 / $32,037.66
| Facility | | $587.26 | $4,904.00 | $32,037.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.41 / $703.85 / $855.12
| Professional | | $526.41 | $703.85 | $855.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,434.50 / $5,434.50 / $5,434.50
| Facility | | $5,434.50 | $5,434.50 | $5,434.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.09 / $778.66 / $1,424.02
| Professional | | $575.09 | $778.66 | $1,424.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,865.76 / $7,621.48 / $36,478.73
| Facility | | $4,865.76 | $7,621.48 | $36,478.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.67 / $775.63 / $1,416.24
| Professional | | $582.67 | $775.63 | $1,416.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,783.00 / $2,783.00 / $2,783.00
| Facility | | $2,783.00 | $2,783.00 | $2,783.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.38 / $884.70 / $1,822.48
| Professional | | $672.38 | $884.70 | $1,822.48 |