- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58,035.94 / $58,035.94 / $58,035.94
| Facility | | $58,035.94 | $58,035.94 | $58,035.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53,630.37 / $55,272.32 / $58,035.94
| Professional | | $53,630.37 | $55,272.32 | $58,035.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,529.12 / $52,396.12 / $89,941.45
| Facility | | $23,529.12 | $52,396.12 | $89,941.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $58,035.94 / $75,584.89
| Professional | | $55,272.32 | $58,035.94 | $75,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,000.00 / $52,143.70 / $55,272.32
| Facility | | $50,000.00 | $52,143.70 | $55,272.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $58,673.83
| Professional | | $55,272.32 | $55,272.32 | $58,673.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,200.00 / $53,981.46 / $93,154.29
| Facility | | $37,200.00 | $53,981.46 | $93,154.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,200.00 / $37,200.00 / $91,737.77
| Professional | | $37,200.00 | $37,200.00 | $91,737.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,298.39 / $57,044.00 / $133,267.52
| Professional | | $55,298.39 | $57,044.00 | $133,267.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,981.47 / $58,588.66 / $60,799.55
| Professional | | $46,981.47 | $58,588.66 | $60,799.55 |