- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $51,286.14
| Professional | | $43,651.58 | $43,651.58 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $40,738.03 / $54,954.09
| Facility | | $33,884.42 | $40,738.03 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Professional | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $46,773.51
| Professional | | $43,651.58 | $43,651.58 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $47,863.01
| Facility | | $43,651.58 | $45,708.82 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,307.81 / $43,651.58 / $51,286.14
| Professional | | $36,307.81 | $43,651.58 | $51,286.14 |