- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $54,954.09
| Facility | | $54,954.09 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $75,857.76
| Professional | | $54,954.09 | $54,954.09 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $63,095.73 / $67,608.30
| Facility | | $54,954.09 | $63,095.73 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50,118.72 / $63,095.73 / $63,095.73
| Professional | | $50,118.72 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70,794.58 / $85,113.80 / $138,038.43
| Facility | | $70,794.58 | $85,113.80 | $138,038.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $58,884.37 / $70,794.58
| Professional | | $54,954.09 | $58,884.37 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67,608.30 / $107,151.93 / $208,929.61
| Facility | | $67,608.30 | $107,151.93 | $208,929.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $66,069.34
| Professional | | $54,954.09 | $54,954.09 | $66,069.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $56,234.13 / $100,000.00
| Facility | | $56,234.13 | $56,234.13 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56,234.13 / $57,543.99 / $100,000.00
| Professional | | $56,234.13 | $57,543.99 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $54,954.09
| Facility | | $54,954.09 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $66,069.34
| Professional | | $54,954.09 | $54,954.09 | $66,069.34 |