- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,481.34 / $35,481.34 / $40,738.03
| Facility | | $35,481.34 | $35,481.34 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,892.96 / $25,703.96 / $40,738.03
| Professional | | $20,892.96 | $25,703.96 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $53,703.18 / $58,884.37
| Professional | | $40,738.03 | $53,703.18 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56,234.13 / $56,234.13 / $70,794.58
| Professional | | $56,234.13 | $56,234.13 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $40,738.03 / $223,872.11
| Facility | | $21,379.62 | $40,738.03 | $223,872.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $24,547.09 / $48,977.88
| Professional | | $19,498.45 | $24,547.09 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $70,794.58 / $70,794.58
| Facility | | $28,183.83 | $70,794.58 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $32,359.37 / $51,286.14
| Professional | | $16,982.44 | $32,359.37 | $51,286.14 |