- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,845.26 / $34,108.90 / $34,108.90
| Facility | | $29,845.26 | $34,108.90 | $34,108.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,708.30 / $34,108.87
| Professional | | $28,424.06 | $28,708.30 | $34,108.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,928.48 / $12,928.48 / $14,221.33
| Facility | | $12,928.48 | $12,928.48 | $14,221.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,123.60 / $6,123.60 / $18,010.64
| Professional | | $6,123.60 | $6,123.60 | $18,010.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,070.53 / $28,424.06 / $28,424.06
| Facility | | $27,070.53 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,781.46 / $28,424.06 / $28,424.06
| Professional | | $25,781.46 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,781.46 / $27,070.53 / $36,003.80
| Professional | | $25,781.46 | $27,070.53 | $36,003.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,002.86 / $28,424.06 / $41,214.89
| Professional | | $27,002.86 | $28,424.06 | $41,214.89 |