- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69,183.10 / $69,183.10 / $69,183.10
| Facility | | $69,183.10 | $69,183.10 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,565.42 / $67,608.30 / $69,183.10
| Professional | | $64,565.42 | $67,608.30 | $69,183.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $114,815.36 / $194,984.46
| Facility | | $56,234.13 | $114,815.36 | $194,984.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63,095.73 / $64,565.42 / $109,647.82
| Professional | | $63,095.73 | $64,565.42 | $109,647.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,565.42 / $64,565.42 / $64,565.42
| Professional | | $64,565.42 | $64,565.42 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69,183.10 / $69,183.10 / $69,183.10
| Facility | | $69,183.10 | $69,183.10 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,183.10 / $69,183.10 / $69,183.10
| Professional | | $69,183.10 | $69,183.10 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66,069.34 / $77,624.71 / $104,712.85
| Professional | | $66,069.34 | $77,624.71 | $104,712.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67,608.30 / $81,283.05 / $120,226.44
| Facility | | $67,608.30 | $81,283.05 | $120,226.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,565.42 / $77,624.71 / $100,000.00
| Facility | | $64,565.42 | $77,624.71 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,565.42 / $77,624.71 / $100,000.00
| Professional | | $64,565.42 | $77,624.71 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $56,234.13 / $93,325.43
| Facility | | $56,234.13 | $56,234.13 | $93,325.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,608.30 / $67,608.30 / $81,283.05
| Professional | | $67,608.30 | $67,608.30 | $81,283.05 |