- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,946.00 / $57,483.21
| Facility | | $55,272.32 | $55,946.00 | $57,483.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.31 / $55,272.32 / $60,799.56
| Professional | | $55,272.31 | $55,272.32 | $60,799.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $88,361.09 / $175,738.34
| Facility | | $55,272.32 | $88,361.09 | $175,738.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $66,712.20
| Professional | | $55,272.32 | $55,272.32 | $66,712.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,143.70 / $55,272.32 / $55,272.32
| Facility | | $52,143.70 | $55,272.32 | $55,272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $59,965.26
| Professional | | $55,272.32 | $55,272.32 | $59,965.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,712.98 / $51,712.98 / $63,090.00
| Facility | | $51,712.98 | $51,712.98 | $63,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $65,774.06
| Professional | | $55,272.32 | $55,272.32 | $65,774.06 |