- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,070.53 / $29,276.78 / $54,549.23
| Facility | | $27,070.53 | $29,276.78 | $54,549.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,708.30 / $31,266.46
| Professional | | $28,424.06 | $28,708.30 | $31,266.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,020.60 / $61,995.44 / $118,129.31
| Facility | | $33,020.60 | $61,995.44 | $118,129.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,512.34 / $30,118.77 / $39,096.49
| Professional | | $27,512.34 | $30,118.77 | $39,096.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $33,518.94
| Professional | | $28,424.06 | $28,424.06 | $33,518.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,070.53 / $38,059.80 / $81,462.60
| Facility | | $27,070.53 | $38,059.80 | $81,462.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,708.30 / $34,450.00
| Professional | | $28,424.06 | $28,708.30 | $34,450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,070.53 / $29,777.58 / $40,605.79
| Professional | | $27,070.53 | $29,777.58 | $40,605.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $31,641.95 / $34,393.11
| Professional | | $28,424.06 | $31,641.95 | $34,393.11 |