- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,144.72 / $24,070.50 / $24,070.50
| Facility | | $23,144.72 | $24,070.50 | $24,070.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,069.43 / $23,618.54 / $25,782.42
| Professional | | $21,069.43 | $23,618.54 | $25,782.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,273.91 / $48,632.79 / $51,113.06
| Facility | | $30,273.91 | $48,632.79 | $51,113.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,746.56 / $25,952.62 / $27,870.24
| Professional | | $22,746.56 | $25,952.62 | $27,870.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,474.58 / $67,719.06 / $77,898.60
| Facility | | $36,474.58 | $67,719.06 | $77,898.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,201.15 / $60,463.45 / $80,244.10
| Professional | | $46,201.15 | $60,463.45 | $80,244.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $56,991.55
| Facility | | $31,290.51 | $31,290.51 | $56,991.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $31,290.51 / $231,985.69
| Professional | | $22,842.07 | $31,290.51 | $231,985.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,981.37 / $29,245.58 / $36,556.97
| Professional | | $23,981.37 | $29,245.58 | $36,556.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,174.91 / $24,262.36 / $33,219.35
| Professional | | $16,174.91 | $24,262.36 | $33,219.35 |