- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,271.68 / $47,271.68 / $54,024.78
| Facility | | $47,271.68 | $47,271.68 | $54,024.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,020.65 / $45,470.86 / $54,024.78
| Professional | | $45,020.65 | $45,470.86 | $54,024.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,830.58 / $25,830.58 / $28,413.64
| Facility | | $25,830.58 | $25,830.58 | $28,413.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,111.52 / $17,111.52 / $38,257.81
| Professional | | $17,111.52 | $17,111.52 | $38,257.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,020.65 / $45,020.65 / $45,020.65
| Facility | | $45,020.65 | $45,020.65 | $45,020.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,575.94 / $45,020.65 / $45,020.65
| Professional | | $44,575.94 | $45,020.65 | $45,020.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,578.75 / $45,212.04 / $60,132.01
| Professional | | $44,578.75 | $45,212.04 | $60,132.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42,769.62 / $45,020.65 / $61,228.08
| Professional | | $42,769.62 | $45,020.65 | $61,228.08 |