- 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
- $65,094.44 / $65,094.44 / $81,368.05
| Professional | | $65,094.44 | $65,094.44 | $81,368.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105,125.42 / $122,172.78 / $126,718.75
| Facility | | $105,125.42 | $122,172.78 | $126,718.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56,745.87 / $67,806.71 / $180,888.46
| Professional | | $56,745.87 | $67,806.71 | $180,888.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,485.58 / $69,162.84 / $141,797.38
| Facility | | $53,485.58 | $69,162.84 | $141,797.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53,485.58 / $101,574.26 / $115,425.30
| Professional | | $53,485.58 | $101,574.26 | $115,425.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,021.25 / $65,094.44 / $82,351.31
| Facility | | $48,021.25 | $65,094.44 | $82,351.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,021.25 / $64,132.46 / $82,351.31
| Facility | | $48,021.25 | $64,132.46 | $82,351.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $92,840.95
| Professional | | $67,806.71 | $67,806.71 | $92,840.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $85.00 / $237,679.98
| Professional | | $55.00 | $85.00 | $237,679.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,021.25 / $65,094.44 / $82,351.31
| Facility | | $48,021.25 | $65,094.44 | $82,351.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,840.30 / $133,591.47 / $196,689.33
| Professional | | $1,840.30 | $133,591.47 | $196,689.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $284,122.75
| Facility | | $69,162.84 | $69,162.84 | $284,122.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $82,500.50 / $281,672.84
| Professional | | $69,162.84 | $82,500.50 | $281,672.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $81,368.05
| Professional | | $67,806.71 | $67,806.71 | $81,368.05 |