- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,383.47 / $38,383.47 / $38,383.47
| Professional | | $38,383.47 | $38,383.47 | $38,383.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $31,019.05
| Professional | | $31,019.05 | $31,019.05 | $31,019.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,706.21 / $27,706.21 / $27,706.21
| Facility | | $27,706.21 | $27,706.21 | $27,706.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,359.33 / $37,559.10 / $104,770.11
| Professional | | $36,359.33 | $37,559.10 | $104,770.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,428.79 / $36,428.79 / $38,609.26
| Facility | | $36,428.79 | $36,428.79 | $38,609.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,104.68 / $38,609.26 / $94,077.13
| Professional | | $30,104.68 | $38,609.26 | $94,077.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,706.21 / $27,706.21 / $36,428.79
| Facility | | $27,706.21 | $27,706.21 | $36,428.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $37,630.85 / $94,077.13
| Professional | | $31,019.05 | $37,630.85 | $94,077.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,771.39 / $39,811.83 / $51,928.49
| Professional | | $20,771.39 | $39,811.83 | $51,928.49 |