- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $66,069.34 / $104,712.85
| Facility | | $37,153.52 | $66,069.34 | $104,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $7,943.28 / $28,183.83
| Professional | | $6,918.31 | $7,943.28 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $40,738.03
| Facility | | $8,511.38 | $8,511.38 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $27,542.29
| Professional | | $8,511.38 | $8,511.38 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $31,622.78 / $33,884.42
| Facility | | $8,511.38 | $31,622.78 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,054.61
| Professional | | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $23,442.29 / $40,738.03
| Facility | | $6,760.83 | $23,442.29 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $16,982.44 / $25,703.96
| Professional | | $5,128.61 | $16,982.44 | $25,703.96 |