- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $128,824.96 / $165,958.69
| Facility | | $43,651.58 | $128,824.96 | $165,958.69 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $70,794.58
| Professional | | $43,651.58 | $43,651.58 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $43,651.58 / $43,651.58
| Facility | | $40,738.03 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $54,954.09
| Professional | | $43,651.58 | $43,651.58 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,307.81 / $43,651.58 / $53,703.18
| Professional | | $36,307.81 | $43,651.58 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $50,118.72
| Facility | | $43,651.58 | $43,651.58 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $47,863.01 / $51,286.14
| Professional | | $43,651.58 | $47,863.01 | $51,286.14 |