- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.30 / $55,272.32 / $55,272.32
| Facility | | $55,272.30 | $55,272.32 | $55,272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.31 / $55,272.32 / $56,930.49
| Professional | | $55,272.31 | $55,272.32 | $56,930.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $58,092.90 / $72,616.13
| Professional | | $55,272.32 | $58,092.90 | $72,616.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,062.44 / $58,183.81 / $99,490.18
| Facility | | $53,062.44 | $58,183.81 | $99,490.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,945.97 / $63,218.95 / $245,198.88
| Professional | | $55,945.97 | $63,218.95 | $245,198.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $66,824.33
| Professional | | $55,272.32 | $55,272.32 | $66,824.33 |