- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $53,703.18
| Professional | | $43,651.58 | $43,651.58 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,481.34 / $70,794.58 / $95,499.26
| Facility | | $35,481.34 | $70,794.58 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $114,815.36
| Facility | | $54,954.09 | $54,954.09 | $114,815.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $56,234.13
| Professional | | $43,651.58 | $43,651.58 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $46,773.51 / $100,000.00
| Facility | | $19,054.61 | $46,773.51 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $46,773.51 / $100,000.00
| Professional | | $19,054.61 | $46,773.51 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $43,651.58 / $74,131.02
| Facility | | $19,054.61 | $43,651.58 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $54,954.09 / $58,884.37
| Professional | | $79.43 | $54,954.09 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $45,708.82
| Professional | | $43,651.58 | $43,651.58 | $45,708.82 |