- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $38,904.51 / $51,286.14
| Facility | | $23,442.29 | $38,904.51 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,125.38 / $15,848.93 / $15,848.93
| Professional | | $14,125.38 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $42,657.95 / $87,096.36
| Facility | | $21,379.62 | $42,657.95 | $87,096.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $30,902.95
| Facility | | $30,902.95 | $30,902.95 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $16,218.10
| Professional | | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $25,703.96
| Facility | | $15,848.93 | $15,848.93 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72,443.60 / $85,113.80 / $112,201.85
| Facility | | $72,443.60 | $85,113.80 | $112,201.85 |