- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $26,915.35 / $36,307.81
| Professional | | $19,498.45 | $26,915.35 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,307.81 / $37,153.52 / $61,659.50
| Facility | | $36,307.81 | $37,153.52 | $61,659.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $42,657.95 / $42,657.95
| Professional | | $40,738.03 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $30,902.95
| Professional | | $30,902.95 | $30,902.95 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $37,153.52 / $46,773.51
| Facility | | $27,542.29 | $37,153.52 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,542.29 / $35,481.34 / $40,738.03
| Professional | | $27,542.29 | $35,481.34 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,307.81 / $37,153.52 / $37,153.52
| Facility | | $36,307.81 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,542.29 / $28,183.83 / $42,657.95
| Professional | | $27,542.29 | $28,183.83 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $38,904.51 / $40,738.03
| Professional | | $38,018.94 | $38,904.51 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $23,442.29 / $23,442.29
| Facility | | $19,952.62 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $25,118.86
| Professional | | $19,952.62 | $19,952.62 | $25,118.86 |