- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $55,272.32
| Facility | | $55,272.32 | $55,272.32 | $55,272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.31 / $55,272.32 / $64,897.30
| Professional | | $55,272.31 | $55,272.32 | $64,897.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,038.96 / $40,094.32 / $53,939.70
| Facility | | $33,038.96 | $40,094.32 | $53,939.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,945.97 / $55,945.97 / $69,932.48
| Professional | | $55,945.97 | $55,945.97 | $69,932.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $55,272.32
| Facility | | $55,272.32 | $55,272.32 | $55,272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $70,394.00
| Professional | | $55,272.32 | $55,272.32 | $70,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,981.47 / $55,272.32 / $58,588.66
| Professional | | $46,981.47 | $55,272.32 | $58,588.66 |