- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $26,302.68 / $63,095.73
| Facility | | $18,620.87 | $26,302.68 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $12,022.64 / $30,199.52
| Professional | | $1,148.15 | $12,022.64 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $25,118.86 / $48,977.88
| Facility | | $20,417.38 | $25,118.86 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $6,918.31 / $24,547.09
| Professional | | $1,071.52 | $6,918.31 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $18,197.01
| Facility | | $741.31 | $1,071.52 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $28,840.32 / $28,840.32
| Professional | | $2,454.71 | $28,840.32 | $28,840.32 |