- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.31 / $55,272.32 / $172,361.00
| Professional | | $55,272.31 | $55,272.32 | $172,361.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,143.70 / $64,547.66 / $107,579.44
| Facility | | $52,143.70 | $64,547.66 | $107,579.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $107,579.44
| Professional | | $55,272.32 | $55,272.32 | $107,579.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,143.70 / $64,547.66 / $107,579.44
| Facility | | $52,143.70 | $64,547.66 | $107,579.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $55,272.32 / $107,579.44
| Professional | | $55,272.32 | $55,272.32 | $107,579.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,272.32 / $58,588.66 / $66,147.00
| Professional | | $55,272.32 | $58,588.66 | $66,147.00 |