- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66,537.39 / $67,535.48 / $116,441.00
| Facility | | $66,537.39 | $67,535.48 | $116,441.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65,094.44 / $67,535.48 / $67,535.48
| Professional | | $65,094.44 | $67,535.48 | $67,535.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73,485.12 / $80,098.78 / $85,977.59
| Professional | | $73,485.12 | $80,098.78 | $85,977.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,824.55 / $69,162.84 / $69,162.84
| Facility | | $56,824.55 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $69,162.84
| Professional | | $69,162.84 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76,603.47 / $284,122.75 / $284,122.75
| Facility | | $76,603.47 | $284,122.75 | $284,122.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281,672.84 / $304,629.20 / $350,237.97
| Professional | | $281,672.84 | $304,629.20 | $350,237.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $67,806.71
| Professional | | $67,806.71 | $67,806.71 | $67,806.71 |