- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $30,199.52 / $47,863.01
| Facility | | $21,379.62 | $30,199.52 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,125.38 / $15,848.93 / $19,952.62
| Professional | | $14,125.38 | $15,848.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $74,131.02 / $117,489.76
| Facility | | $63,095.73 | $74,131.02 | $117,489.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,218.10 / $30,902.95 / $35,481.34
| Professional | | $16,218.10 | $30,902.95 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $15,848.93 / $18,197.01
| Facility | | $14,125.38 | $15,848.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $15,848.93 / $44,668.36
| Facility | | $13,489.63 | $15,848.93 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Professional | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $58.88 / $85.11
| Professional | | $50.12 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $25,703.96
| Professional | | $16,218.10 | $16,218.10 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $46,773.51 / $61,659.50
| Facility | | $46,773.51 | $46,773.51 | $61,659.50 |