- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $37,153.52 / $39,810.72
| Facility | | $28,183.83 | $37,153.52 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $25,118.86 / $40,738.03
| Professional | | $20,417.38 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $72,443.60 / $100,000.00
| Facility | | $42,657.95 | $72,443.60 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34,673.69 / $34,673.69 / $34,673.69
| Professional | | $34,673.69 | $34,673.69 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Facility | | $31,622.78 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $46,773.51
| Professional | | $22,908.68 | $22,908.68 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $38,904.51 / $58,884.37
| Facility | | $28,183.83 | $38,904.51 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,454.40 / $22,908.68 / $33,113.11
| Professional | | $14,454.40 | $22,908.68 | $33,113.11 |