- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,560.40 / $54,945.85 / $99,429.00
| Facility | | $45,560.40 | $54,945.85 | $99,429.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,020.65 / $45,020.65 / $55,128.10
| Professional | | $45,020.65 | $45,020.65 | $55,128.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,020.65 / $71,972.25 / $131,185.67
| Facility | | $45,020.65 | $71,972.25 | $131,185.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,020.65 / $45,020.65 / $53,540.04
| Professional | | $45,020.65 | $45,020.65 | $53,540.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,472.31 / $45,020.65 / $47,524.89
| Facility | | $42,472.31 | $45,020.65 | $47,524.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,020.65 / $45,020.65 / $48,843.16
| Professional | | $45,020.65 | $45,020.65 | $48,843.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,020.65 / $45,020.65 / $53,574.57
| Professional | | $45,020.65 | $45,020.65 | $53,574.57 |