- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,197.01 / $30,902.95
| Facility | | $13,803.84 | $18,197.01 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Professional | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $58.88 / $70.79
| Professional | | $50.12 | $58.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97,723.72 / $97,723.72 / $147,910.84
| Facility | | $97,723.72 | $97,723.72 | $147,910.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $2,089.30 / $2,089.30
| Professional | | $831.76 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $21,877.62 / $23,442.29
| Facility | | $20,892.96 | $21,877.62 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,202.26 / $1,202.26
| Professional | | $602.56 | $1,202.26 | $1,202.26 |