- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,358.30 / $22,358.33 / $46,980.40
| Facility | | $22,358.30 | $22,358.33 | $46,980.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,405.97 / $22,358.33 / $23,252.66
| Professional | | $19,405.97 | $22,358.33 | $23,252.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,114.50 / $42,047.44 / $46,980.38
| Facility | | $37,114.50 | $42,047.44 | $46,980.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,537.37 / $23,953.47 / $33,055.78
| Professional | | $23,537.37 | $23,953.47 | $33,055.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,327.16 / $49,329.40 / $65,772.53
| Facility | | $33,327.16 | $49,329.40 | $65,772.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39,933.32 / $51,678.42 / $63,423.51
| Professional | | $39,933.32 | $51,678.42 | $63,423.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $46,980.38
| Facility | | $30,391.12 | $30,391.12 | $46,980.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $47,710.27
| Professional | | $22,185.52 | $30,391.12 | $47,710.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,040.44 / $23,438.00 / $31,391.01
| Professional | | $13,040.44 | $23,438.00 | $31,391.01 |