- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $153,595.68
| Facility | | $55,272.32 | $55,272.32 | $153,595.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.31 / $55,272.32 / $58,035.94
| Professional | | $55,272.31 | $55,272.32 | $58,035.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,536.50 / $58,584.93 / $67,029.61
| Professional | | $55,536.50 | $58,584.93 | $67,029.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $55,536.50
| Facility | | $55,272.32 | $55,272.32 | $55,536.50 |
- 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
- $73,522.62 / $79,873.97 / $285,085.50
| Facility | | $73,522.62 | $79,873.97 | $285,085.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245,198.88 / $245,198.88 / $245,198.88
| Professional | | $245,198.88 | $245,198.88 | $245,198.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52,508.70 / $55,272.32 / $65,221.34
| Professional | | $52,508.70 | $55,272.32 | $65,221.34 |