- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,020.00 / $23,020.02 / $48,370.80
| Facility | | $23,020.00 | $23,020.02 | $48,370.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,020.02 / $23,618.54 / $24,070.50
| Professional | | $23,020.02 | $23,618.54 | $24,070.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,212.90 / $43,291.83 / $48,370.76
| Facility | | $38,212.90 | $43,291.83 | $48,370.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,233.94 / $27,870.24 / $37,624.82
| Professional | | $24,233.94 | $27,870.24 | $37,624.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,474.58 / $53,207.84 / $72,556.14
| Facility | | $36,474.58 | $53,207.84 | $72,556.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,115.15 / $53,207.84 / $65,300.53
| Professional | | $41,115.15 | $53,207.84 | $65,300.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $48,370.76
| Facility | | $31,290.51 | $31,290.51 | $48,370.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $31,290.51 / $49,619.03
| Professional | | $22,842.07 | $31,290.51 | $49,619.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,371.62 / $24,131.64 / $33,219.35
| Professional | | $14,371.62 | $24,131.64 | $33,219.35 |