- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,295.74 / $15,295.74 / $39,272.85
| Facility | | $15,295.74 | $15,295.74 | $39,272.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,295.74 / $21,245.07 / $39,272.85
| Professional | | $15,295.74 | $21,245.07 | $39,272.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,211.27 / $47,211.27 / $47,211.27
| Facility | | $47,211.27 | $47,211.27 | $47,211.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,952.62 / $27,870.24 / $57,614.51
| Professional | | $25,952.62 | $27,870.24 | $57,614.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $34,755.85
| Facility | | $31,290.51 | $31,290.51 | $34,755.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $30,618.09 / $32,229.23
| Professional | | $22,842.07 | $30,618.09 | $32,229.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,931.61 / $23,195.18 / $35,929.06
| Professional | | $19,931.61 | $23,195.18 | $35,929.06 |