- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $95,499.26
| Facility | | $43,651.58 | $45,708.82 | $95,499.26 |
- 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
- $47,863.01 / $47,863.01 / $47,863.01
| Facility | | $47,863.01 | $47,863.01 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47,863.01 / $47,863.01 / $47,863.01
| Professional | | $47,863.01 | $47,863.01 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $43,651.58
| Facility | | $40,738.03 | $40,738.03 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $44,668.36
| Professional | | $43,651.58 | $43,651.58 | $44,668.36 |
- 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
- $38,904.51 / $43,651.58 / $50,118.72
| Professional | | $38,904.51 | $43,651.58 | $50,118.72 |