- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $58,035.94 / $58,035.94
| Facility | | $55,272.32 | $58,035.94 | $58,035.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $58,035.94
| Professional | | $55,272.32 | $55,272.32 | $58,035.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,272.32 / $114,413.70 / $180,740.49
| Facility | | $55,272.32 | $114,413.70 | $180,740.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $74,087.00
| Professional | | $55,272.32 | $55,272.32 | $74,087.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,945.97 / $55,945.97
| Professional | | $55,272.32 | $55,945.97 | $55,945.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,143.70 / $52,143.70 / $55,272.32
| Facility | | $52,143.70 | $52,143.70 | $55,272.32 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $46,981.47 / $55,272.32 / $70,038.00
| Professional | | $46,981.47 | $55,272.32 | $70,038.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,200.00 / $56,930.49 / $90,635.33
| Facility | | $37,200.00 | $56,930.49 | $90,635.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,873.00 / $74,974.00 / $94,467.56
| Professional | | $46,873.00 | $74,974.00 | $94,467.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $58,588.66 / $65,276.86
| Professional | | $55,272.32 | $58,588.66 | $65,276.86 |