- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $75,857.76 / $128,824.96
| Facility | | $43,651.58 | $75,857.76 | $128,824.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $58,884.37
| Professional | | $43,651.58 | $43,651.58 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $58,884.37 / $128,824.96
| Facility | | $46,773.51 | $58,884.37 | $128,824.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $60,255.96
| Professional | | $43,651.58 | $43,651.58 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $43,651.58 / $67,608.30
| Facility | | $40,738.03 | $43,651.58 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $53,703.18
| Professional | | $43,651.58 | $43,651.58 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $44,668.36 / $74,131.02
| Facility | | $43,651.58 | $44,668.36 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $50,118.72
| Professional | | $43,651.58 | $45,708.82 | $50,118.72 |