- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,401.22 / $24,450.56 / $30,695.25
| Facility | | $24,401.22 | $24,450.56 | $30,695.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,069.43 / $24,450.56 / $36,196.87
| Professional | | $21,069.43 | $24,450.56 | $36,196.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,211.27 / $50,539.73 / $94,422.54
| Facility | | $47,211.27 | $50,539.73 | $94,422.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,025.68 / $27,870.24 / $38,608.02
| Professional | | $27,025.68 | $27,870.24 | $38,608.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $31,290.51
| Facility | | $31,290.51 | $31,290.51 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $29,245.58 / $32,229.23
| Professional | | $22,842.07 | $29,245.58 | $32,229.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,974.56 / $24,260.11 / $34,189.94
| Professional | | $17,974.56 | $24,260.11 | $34,189.94 |