- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $33,113.11 / $79,432.82
| Facility | | $22,908.68 | $33,113.11 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,365.16 / $36,307.81
| Professional | | $1,380.38 | $4,365.16 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $31,622.78 / $63,095.73
| Facility | | $25,703.96 | $31,622.78 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $12,589.25 / $32,359.37
| Professional | | $1,380.38 | $12,589.25 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $14,454.40 / $50,118.72
| Facility | | $1,096.48 | $14,454.40 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $21,877.62 / $48,977.88
| Professional | | $13,182.57 | $21,877.62 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $8,128.31 / $36,307.81
| Professional | | $977.24 | $8,128.31 | $36,307.81 |