- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $55,272.32
| Facility | | $55,272.32 | $55,272.32 | $55,272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.31 / $55,272.32 / $55,825.05
| Professional | | $55,272.31 | $55,272.32 | $55,825.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62,572.44 / $65,179.63 / $110,544.64
| Facility | | $62,572.44 | $65,179.63 | $110,544.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $55,272.32
| Professional | | $55,272.32 | $55,272.32 | $55,272.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $74,617.63 / $88,435.71
| Facility | | $55,272.32 | $74,617.63 | $88,435.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $60,799.55 / $85,119.37
| Professional | | $55,272.32 | $60,799.55 | $85,119.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $66,147.00 / $66,147.00
| Facility | | $55,272.32 | $66,147.00 | $66,147.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $76,645.98
| Professional | | $55,272.32 | $55,272.32 | $76,645.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,945.97 / $57,017.10 / $74,122.23
| Professional | | $55,945.97 | $57,017.10 | $74,122.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $58,588.66 / $61,529.70
| Professional | | $55,272.32 | $58,588.66 | $61,529.70 |