- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,466.84 / $11,481.54
| Facility | | $1,023.29 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $489.78 / $1,000.00
| Professional | | $245.47 | $489.78 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $32,359.37 / $38,018.94
| Facility | | $28,840.32 | $32,359.37 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $346.74
| Professional | | $120.23 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $21,877.62 / $52,480.75
| Facility | | $4,265.80 | $21,877.62 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,258.93 / $1,862.09
| Professional | | $776.25 | $1,258.93 | $1,862.09 |