- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $87,096.36 / $138,038.43
| Facility | | $44,668.36 | $87,096.36 | $138,038.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $54,954.09
| Professional | | $43,651.58 | $43,651.58 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $95,499.26 / $190,546.07
| Facility | | $50,118.72 | $95,499.26 | $190,546.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,686.94 / $43,651.58 / $45,708.82
| Professional | | $41,686.94 | $43,651.58 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $48,977.88
| Professional | | $43,651.58 | $43,651.58 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $107,151.93 / $138,038.43
| Facility | | $43,651.58 | $107,151.93 | $138,038.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $57,543.99
| Professional | | $43,651.58 | $43,651.58 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $48,977.88
| Professional | | $43,651.58 | $43,651.58 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $44,668.36 / $45,708.82
| Facility | | $43,651.58 | $44,668.36 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $53,703.18
| Professional | | $43,651.58 | $45,708.82 | $53,703.18 |