- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.17 / $21,526.00 / $32,120.74
| Facility | | $3,090.17 | $21,526.00 | $32,120.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.85 / $189.23 / $5,709.32
| Professional | | $84.85 | $189.23 | $5,709.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.43 / $104.21 / $113.54
| Facility | | $91.43 | $104.21 | $113.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.92 / $100.92 / $100.92
| Professional | | $100.92 | $100.92 | $100.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.61 / $146.61 / $146.61
| Facility | | $146.61 | $146.61 | $146.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.74 / $402.23 / $10,228.62
| Professional | | $117.74 | $402.23 | $10,228.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,803.54 / $22,315.00 / $38,932.69
| Facility | | $8,803.54 | $22,315.00 | $38,932.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,203.08 / $23,203.08 / $23,203.08
| Facility | | $23,203.08 | $23,203.08 | $23,203.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,547.41 / $5,678.70 / $9,927.56
| Professional | | $3,547.41 | $5,678.70 | $9,927.56 |