- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,951.21 / $21,379.62
| Facility | | $398.11 | $2,951.21 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $38,904.51 / $38,904.51
| Facility | | $28,183.83 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $1,412.54 / $1,778.28
| Professional | | $177.83 | $1,412.54 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,202.26 / $3,235.94
| Facility | | $239.88 | $1,202.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $295.12 / $16,982.44
| Facility | | $199.53 | $295.12 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,135.61 / $29,512.09
| Facility | | $8,317.64 | $15,135.61 | $29,512.09 |