- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $50,118.72 / $190,546.07
| Facility | | $43,651.58 | $50,118.72 | $190,546.07 |
- 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
- $52,480.75 / $56,234.13 / $56,234.13
| Facility | | $52,480.75 | $56,234.13 | $56,234.13 |
- 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
- $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 / $43,651.58
| Professional | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $48,977.88 / $70,794.58
| Facility | | $26,302.68 | $48,977.88 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,708.82 / $47,863.01 / $199,526.23
| Professional | | $45,708.82 | $47,863.01 | $199,526.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $44,668.36 / $47,863.01
| Facility | | $43,651.58 | $44,668.36 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $51,286.14
| Professional | | $43,651.58 | $45,708.82 | $51,286.14 |