- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,438.20 / $25,438.20 / $30,525.80
| Facility | | $25,438.20 | $25,438.20 | $30,525.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,714.66 / $19,739.45 / $25,438.20
| Professional | | $18,714.66 | $19,739.45 | $25,438.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,177.95 / $45,177.95 / $53,553.94
| Facility | | $45,177.95 | $45,177.95 | $53,553.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,953.47 / $23,953.47 / $25,020.52
| Professional | | $23,953.47 | $23,953.47 | $25,020.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $30,391.12
| Facility | | $30,391.12 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $22,185.52 / $32,398.44
| Professional | | $22,185.52 | $22,185.52 | $32,398.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,578.56 / $36,578.56 / $112,899.73
| Professional | | $36,578.56 | $36,578.56 | $112,899.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,025.85 / $22,538.78 / $29,465.37
| Professional | | $15,025.85 | $22,538.78 | $29,465.37 |