- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.43 / $9,493.50 / $34,142.26
| Facility | | $986.43 | $9,493.50 | $34,142.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,859.17 / $3,859.17 / $8,775.00
| Professional | | $3,859.17 | $3,859.17 | $8,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $20.01 / $20.01
| Professional | | $17.00 | $20.01 | $20.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.47 / $367.47 / $367.47
| Facility | | $367.47 | $367.47 | $367.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.50 / $1,326.50 / $1,326.50
| Professional | | $1,326.50 | $1,326.50 | $1,326.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,039.00 / $24,801.49 / $27,994.35
| Facility | | $6,039.00 | $24,801.49 | $27,994.35 |