- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $97,723.72 / $165,958.69
| Facility | | $43,651.58 | $97,723.72 | $165,958.69 |
- 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 / $74,131.02 / $151,356.12
| Facility | | $46,773.51 | $74,131.02 | $151,356.12 |
- 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
- $40,738.03 / $40,738.03 / $57,543.99
| Facility | | $40,738.03 | $40,738.03 | $57,543.99 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $64,565.42 / $89,125.09
| Professional | | $43,651.58 | $64,565.42 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $43,651.58
| Professional | | $40,738.03 | $40,738.03 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $45,708.82
| Professional | | $43,651.58 | $43,651.58 | $45,708.82 |