- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $4,786.30 / $13,489.63
| Facility | | $912.01 | $4,786.30 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $37,153.52 / $50,118.72
| Facility | | $15,848.93 | $37,153.52 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $741.31 / $912.01
| Professional | | $616.60 | $741.31 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,000.00 / $1,698.24
| Facility | | $707.95 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $7,413.10
| Facility | | $691.83 | $1,023.29 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |