- 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
- $65,094.44 / $69,162.84 / $77,299.64
| Professional | | $65,094.44 | $69,162.84 | $77,299.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,476.58 / $154,405.60 / $219,346.54
| Facility | | $65,476.58 | $154,405.60 | $219,346.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65,476.58 / $67,806.71 / $304,629.20
| Professional | | $65,476.58 | $67,806.71 | $304,629.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77,617.83 / $132,939.40 / $244,867.78
| Facility | | $77,617.83 | $132,939.40 | $244,867.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,824.55 / $69,162.84 / $69,162.84
| Facility | | $56,824.55 | $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
- $1,909.00 / $9,239.00 / $85,378.89
| Facility | | $1,909.00 | $9,239.00 | $85,378.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $105,127.52
| Professional | | $69,162.84 | $69,162.84 | $105,127.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77,299.64 / $77,299.64 / $284,122.75
| Facility | | $77,299.64 | $77,299.64 | $284,122.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $304,629.20
| Professional | | $67,806.71 | $67,806.71 | $304,629.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $74,858.61
| Professional | | $67,806.71 | $67,806.71 | $74,858.61 |