- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59,694.11 / $59,694.11 / $59,694.11
| Facility | | $59,694.11 | $59,694.11 | $59,694.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,825.05 / $66,326.78
| Professional | | $55,272.32 | $55,825.05 | $66,326.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,717.85 / $37,409.98 / $59,097.83
| Facility | | $23,717.85 | $37,409.98 | $59,097.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,143.70 / $52,143.70 / $55,272.32
| Facility | | $52,143.70 | $52,143.70 | $55,272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $55,272.32
| Professional | | $55,272.32 | $55,272.32 | $55,272.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,374.20 / $60,421.65 / $88,435.71
| Facility | | $46,374.20 | $60,421.65 | $88,435.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53,148.67 / $57,017.10 / $70,380.03
| Professional | | $53,148.67 | $57,017.10 | $70,380.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $63,563.17
| Professional | | $55,272.32 | $55,272.32 | $63,563.17 |