- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,990.62 / $32,527.80 / $33,569.50
| Facility | | $21,990.62 | $32,527.80 | $33,569.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,990.62 / $25,197.59 / $45,813.80
| Professional | | $21,990.62 | $25,197.59 | $45,813.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,133.08 / $50,539.73 / $222,182.30
| Facility | | $48,133.08 | $50,539.73 | $222,182.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,569.82 / $27,870.24 / $39,591.22
| Professional | | $24,569.82 | $27,870.24 | $39,591.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $31,290.51
| Facility | | $31,290.51 | $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
- $21,990.62 / $38,791.42 / $225,247.51
| Facility | | $21,990.62 | $38,791.42 | $225,247.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,964.53 / $25,728.96 / $42,730.62
| Professional | | $17,964.53 | $25,728.96 | $42,730.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,964.53 / $24,195.53 / $34,085.47
| Professional | | $17,964.53 | $24,195.53 | $34,085.47 |