- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,930.49 / $56,930.49 / $56,930.49
| Facility | | $56,930.49 | $56,930.49 | $56,930.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.31 / $55,272.32 / $57,483.22
| Professional | | $55,272.31 | $55,272.32 | $57,483.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86,509.90 / $161,249.53 / $311,435.64
| Facility | | $86,509.90 | $161,249.53 | $311,435.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61,607.50 / $67,444.00 / $81,062.50
| Professional | | $61,607.50 | $67,444.00 | $81,062.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $66,643.80
| Professional | | $55,272.32 | $55,272.32 | $66,643.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,908.48 / $55,272.32 / $82,908.48
| Facility | | $51,908.48 | $55,272.32 | $82,908.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $66,326.78
| Professional | | $55,272.32 | $55,272.32 | $66,326.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $61,540.56 / $83,918.95
| Professional | | $55,272.32 | $61,540.56 | $83,918.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $61,529.70 / $68,544.09
| Professional | | $55,272.32 | $61,529.70 | $68,544.09 |