- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $45,708.82 / $51,286.14
| Facility | | $45,708.82 | $45,708.82 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $51,286.14
| Professional | | $43,651.58 | $43,651.58 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $28,183.83
| Facility | | $25,703.96 | $25,703.96 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $38,018.94
| Professional | | $16,982.44 | $16,982.44 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $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
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $45,708.82
| Professional | | $30.20 | $30.20 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $47,863.01
| Facility | | $43,651.58 | $45,708.82 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $43,651.58 / $57,543.99
| Professional | | $38,018.94 | $43,651.58 | $57,543.99 |