- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $109,647.82 / $194,984.46
| Facility | | $43,651.58 | $109,647.82 | $194,984.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $52,480.75
| Professional | | $43,651.58 | $43,651.58 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $64,565.42 / $95,499.26
| Facility | | $51,286.14 | $64,565.42 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $64,565.42
| Professional | | $43,651.58 | $43,651.58 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $53,703.18 / $81,283.05
| Facility | | $44,668.36 | $53,703.18 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $44,668.36
| Professional | | $44,668.36 | $44,668.36 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $43,651.58 / $43,651.58
| Facility | | $17,782.79 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $52,480.75
| Professional | | $43,651.58 | $43,651.58 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $91,201.08
| Facility | | $44,668.36 | $44,668.36 | $91,201.08 |
- 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 |