- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,945.27 / $21,603.28 / $25,722.26
| Facility | | $20,945.27 | $21,603.28 | $25,722.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,185.33 / $21,603.28 / $28,804.37
| Professional | | $19,185.33 | $21,603.28 | $28,804.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,217.26 / $40,290.50 / $78,470.38
| Facility | | $38,217.26 | $40,290.50 | $78,470.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,036.73 / $54,000.00 / $54,000.00
| Professional | | $4,036.73 | $54,000.00 | $54,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,867.18 / $43,867.18 / $45,241.78
| Facility | | $43,867.18 | $43,867.18 | $45,241.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $44,937.75
| Professional | | $31,019.05 | $31,019.05 | $44,937.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,561.84 / $20,295.25 / $33,123.69
| Professional | | $16,561.84 | $20,295.25 | $33,123.69 |