- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $72,443.60 / $125,892.54
| Facility | | $44,668.36 | $72,443.60 | $125,892.54 |
- 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
- $50,118.72 / $72,443.60 / $114,815.36
| Facility | | $50,118.72 | $72,443.60 | $114,815.36 |
- 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 / $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 / $43,651.58
| Professional | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $60,255.96
| Professional | | $44,668.36 | $44,668.36 | $60,255.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $43,651.58 / $47,863.01
| Professional | | $40,738.03 | $43,651.58 | $47,863.01 |