- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $46,773.51 / $77,624.71
| Facility | | $173.78 | $46,773.51 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $100.00 / $251.19
| Professional | | $89.13 | $100.00 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $346.74 / $524.81
| Facility | | $107.15 | $346.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $112.20 / $316.23
| Professional | | $100.00 | $112.20 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $123.03 / $218.78
| Professional | | $87.10 | $123.03 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $162.18 / $4,365.16
| Facility | | $95.50 | $162.18 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $114.82 / $1,621.81
| Professional | | $89.13 | $114.82 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,691.53 / $5,495.41
| Facility | | $1,412.54 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $104.71 / $199.53
| Professional | | $85.11 | $104.71 | $199.53 |