- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.07 / $34,838.51 / $37,933.32
| Facility | | $461.07 | $34,838.51 | $37,933.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.93 / $476.28 / $4,879.14
| Professional | | $296.93 | $476.28 | $4,879.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.84 / $650.36 / $5,402.76
| Professional | | $370.84 | $650.36 | $5,402.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $556.26 / $975.54 / $8,104.14
| Professional | 50 | $556.26 | $975.54 | $8,104.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.28 / $640.79 / $8,039.32
| Professional | | $386.28 | $640.79 | $8,039.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.53 / $657.00 / $5,276.73
| Professional | | $332.53 | $657.00 | $5,276.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,194.61 / $34,838.51 / $37,933.32
| Facility | | $17,194.61 | $34,838.51 | $37,933.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.93 / $476.28 / $5,024.26
| Professional | | $296.93 | $476.28 | $5,024.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.78 / $5,414.69 / $6,899.90
| Professional | | $439.78 | $5,414.69 | $6,899.90 |