- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,094.44 / $65,094.44 / $65,094.44
| Facility | | $65,094.44 | $65,094.44 | $65,094.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65,094.44 / $67,535.48 / $81,368.05
| Professional | | $65,094.44 | $67,535.48 | $81,368.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71,197.05 / $71,553.03 / $72,471.48
| Facility | | $71,197.05 | $71,553.03 | $72,471.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60,517.49 / $71,446.24 / $72,471.48
| Professional | | $60,517.49 | $71,446.24 | $72,471.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,927.75 / $64,909.69 / $69,162.84
| Professional | | $51,927.75 | $64,909.69 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,132.46 / $83,372.20 / $114,235.95
| Facility | | $64,132.46 | $83,372.20 | $114,235.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66,804.64 / $67,806.71 / $281,672.84
| Professional | | $66,804.64 | $67,806.71 | $281,672.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $74,587.38
| Professional | | $67,806.71 | $67,806.71 | $74,587.38 |