- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $63,095.73 / $63,095.73
| Facility | | $63,095.73 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $67,608.30
| Professional | | $54,954.09 | $54,954.09 | $67,608.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,565.42 / $81,283.05 / $85,113.80
| Facility | | $64,565.42 | $81,283.05 | $85,113.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $56,234.13
| Professional | | $54,954.09 | $54,954.09 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $54,954.09 / $72,443.60
| Professional | | $38,018.94 | $54,954.09 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89,125.09 / $112,201.85 / $199,526.23
| Facility | | $89,125.09 | $112,201.85 | $199,526.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $60,255.96 / $79,432.82
| Professional | | $54,954.09 | $60,255.96 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47,863.01 / $56,234.13 / $58,884.37
| Professional | | $47,863.01 | $56,234.13 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50,118.72 / $54,954.09 / $66,069.34
| Professional | | $50,118.72 | $54,954.09 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $54,954.09
| Professional | | $54,954.09 | $54,954.09 | $54,954.09 |