- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,113.11 / $58,884.37 / $93,325.43
| Facility | | $33,113.11 | $58,884.37 | $93,325.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,413.10 / $25,118.86
| Professional | | $2,691.53 | $7,413.10 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $36,307.81
| Facility | | $7,585.78 | $7,585.78 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $24,547.09
| Professional | | $7,585.78 | $7,585.78 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $28,183.83 / $30,199.52
| Facility | | $7,585.78 | $28,183.83 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $16,982.44
| Professional | | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $20,892.96 / $36,307.81
| Facility | | $6,025.60 | $20,892.96 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $15,135.61 / $22,908.68
| Professional | | $4,570.88 | $15,135.61 | $22,908.68 |