- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $44,668.36 / $104,712.85
| Facility | | $30,199.52 | $44,668.36 | $104,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $19,054.61 / $47,863.01
| Professional | | $1,513.56 | $19,054.61 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $42,657.95 / $83,176.38
| Facility | | $33,884.42 | $42,657.95 | $83,176.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,570.88 / $41,686.94
| Professional | | $1,479.11 | $4,570.88 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $19,054.61 / $52,480.75
| Facility | | $1,174.90 | $19,054.61 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,218.10 / $26,915.35 / $60,255.96
| Professional | | $16,218.10 | $26,915.35 | $60,255.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $10,715.19 / $44,668.36
| Professional | | $1,023.29 | $10,715.19 | $44,668.36 |