- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,535.48 / $67,535.48 / $67,535.48
| Professional | | $67,535.48 | $67,535.48 | $67,535.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,372.72 / $99,000.00 / $342,649.95
| Facility | | $46,372.72 | $99,000.00 | $342,649.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $80,546.25
| Professional | | $69,162.84 | $69,162.84 | $80,546.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,372.72 / $99,000.00 / $342,649.95
| Facility | | $46,372.72 | $99,000.00 | $342,649.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,072.05 / $69,162.84 / $90,125.66
| Professional | | $54,072.05 | $69,162.84 | $90,125.66 |
- 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 |