- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $107,151.93 / $107,151.93
| Facility | | $41,686.94 | $107,151.93 | $107,151.93 |
- 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
- $41,686.94 / $50,118.72 / $138,038.43
| Facility | | $41,686.94 | $50,118.72 | $138,038.43 |
- 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 / $43,651.58 / $67,608.30
| Facility | | $43,651.58 | $43,651.58 | $67,608.30 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $43,651.58
| Professional | | $40,738.03 | $40,738.03 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $100,000.00 / $107,151.93
| Facility | | $41,686.94 | $100,000.00 | $107,151.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $44,668.36 / $69,183.10
| Professional | | $43,651.58 | $44,668.36 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $43,651.58 / $52,480.75
| Professional | | $40,738.03 | $43,651.58 | $52,480.75 |