- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $87,096.36
| Facility | | $43,651.58 | $43,651.58 | $87,096.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $60,255.96
| Professional | | $43,651.58 | $43,651.58 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,977.88 / $51,286.14 / $81,283.05
| Facility | | $48,977.88 | $51,286.14 | $81,283.05 |
- 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
- $44,668.36 / $44,668.36 / $72,443.60
| Facility | | $44,668.36 | $44,668.36 | $72,443.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $46,773.51 / $64,565.42
| Professional | | $44,668.36 | $46,773.51 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $67,608.30 / $67,608.30
| Facility | | $43,651.58 | $67,608.30 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $190,546.07
| Professional | | $43,651.58 | $43,651.58 | $190,546.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $43,651.58 / $46,773.51
| Professional | | $5,011.87 | $43,651.58 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $47,863.01
| Professional | | $43,651.58 | $45,708.82 | $47,863.01 |