- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,379.62 / $24,547.09 / $72,443.60
| Professional | | $21,379.62 | $24,547.09 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $56,234.13 / $64,565.42
| Facility | | $46,773.51 | $56,234.13 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $47,863.01
| Professional | | $28,183.83 | $28,183.83 | $47,863.01 |
- 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 / $31,622.78
| Professional | | $22,908.68 | $22,908.68 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,686.94 / $41,686.94 / $48,977.88
| Professional | | $41,686.94 | $41,686.94 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,379.62 / $29,512.09 / $72,443.60
| Professional | | $21,379.62 | $29,512.09 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $28,183.83 / $28,183.83
| Facility | | $13,803.84 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $33,113.11 / $45,708.82
| Professional | | $16,982.44 | $33,113.11 | $45,708.82 |