- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,713.69 / $39,686.25 / $39,686.25
| Professional | | $28,713.69 | $39,686.25 | $39,686.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,611.54 / $31,290.51 / $31,290.51
| Facility | | $29,611.54 | $31,290.51 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $22,842.07 / $32,229.23
| Professional | | $22,842.07 | $22,842.07 | $32,229.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,917.11 / $33,255.86 / $47,211.27
| Facility | | $13,917.11 | $33,255.86 | $47,211.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42,490.14 / $44,850.71 / $47,211.27
| Professional | | $42,490.14 | $44,850.71 | $47,211.27 |
- 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
- $41,339.83 / $46,104.76 / $69,157.14
| Facility | | $41,339.83 | $46,104.76 | $69,157.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,047.89 / $34,230.78 / $49,571.83
| Professional | | $33,047.89 | $34,230.78 | $49,571.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,931.61 / $21,557.44 / $34,189.94
| Professional | | $19,931.61 | $21,557.44 | $34,189.94 |