- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,744.84 / $36,965.04 / $36,965.04
| Professional | | $26,744.84 | $36,965.04 | $36,965.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,275.71 / $30,391.12 / $30,391.12
| Facility | | $27,275.71 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $32,398.44
| Professional | | $22,185.52 | $30,391.12 | $32,398.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,628.02 / $33,013.73 / $43,974.09
| Facility | | $12,628.02 | $33,013.73 | $43,974.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39,576.68 / $41,775.39 / $43,974.09
| Professional | | $39,576.68 | $41,775.39 | $43,974.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,505.25 / $42,943.45 / $64,415.18
| Facility | | $38,505.25 | $42,943.45 | $64,415.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,781.86 / $30,781.86 / $46,172.79
| Professional | | $30,781.86 | $30,781.86 | $46,172.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,085.41 / $19,560.65 / $31,023.06
| Professional | | $18,085.41 | $19,560.65 | $31,023.06 |