- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,094.44 / $65,094.44 / $65,094.44
| Facility | | $65,094.44 | $65,094.44 | $65,094.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,132.50 / $65,094.44 / $77,299.64
| Professional | | $64,132.50 | $65,094.44 | $77,299.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,848.06 / $119,055.02 / $216,981.47
| Facility | | $63,848.06 | $119,055.02 | $216,981.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,625.00 / $65,094.44 / $67,806.71
| Professional | | $19,625.00 | $65,094.44 | $67,806.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $69,162.84
| Facility | | $69,162.84 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $69,162.84
| Professional | | $69,162.84 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,094.44 / $72,254.83 / $113,410.39
| Facility | | $65,094.44 | $72,254.83 | $113,410.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73,939.13 / $110,908.70 / $135,308.60
| Professional | | $73,939.13 | $110,908.70 | $135,308.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $67,806.71
| Professional | | $67,806.71 | $67,806.71 | $67,806.71 |