- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $26,915.35 / $36,307.81
| Professional | | $20,417.38 | $26,915.35 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,904.51 / $38,904.51 / $38,904.51
| Professional | | $38,904.51 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $41,686.94 / $41,686.94
| Facility | | $41,686.94 | $41,686.94 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $41,686.94 / $41,686.94
| Professional | | $30,902.95 | $41,686.94 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $38,904.51 / $75,857.76
| Facility | | $37,153.52 | $38,904.51 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,153.52 / $38,904.51 / $75,857.76
| Professional | | $37,153.52 | $38,904.51 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $40,738.03 / $45,708.82
| Facility | | $21,877.62 | $40,738.03 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $36,307.81 / $41,686.94
| Professional | | $79.43 | $36,307.81 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $23,442.29 / $25,118.86
| Facility | | $19,952.62 | $23,442.29 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $23,442.29
| Professional | | $19,952.62 | $19,952.62 | $23,442.29 |