- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $42,657.95 / $42,657.95
| Facility | | $24,547.09 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $25,118.86 / $40,738.03
| Professional | | $20,417.38 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $56,234.13 / $107,151.93
| Facility | | $50,118.72 | $56,234.13 | $107,151.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,703.96 / $28,183.83 / $34,673.69
| Professional | | $25,703.96 | $28,183.83 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Facility | | $31,622.78 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $32,359.37
| Professional | | $22,908.68 | $22,908.68 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,199.52 / $50,118.72 / $97,723.72
| Professional | | $30,199.52 | $50,118.72 | $97,723.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47,863.01 / $50,118.72 / $50,118.72
| Professional | | $47,863.01 | $50,118.72 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $28,840.32 / $33,884.42
| Facility | | $34.67 | $28,840.32 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $21,379.62 / $33,113.11
| Professional | | $19,498.45 | $21,379.62 | $33,113.11 |