- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $125,892.54
| Facility | | $43,651.58 | $43,651.58 | $125,892.54 |
- 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
- $46,773.51 / $46,773.51 / $47,863.01
| Facility | | $46,773.51 | $46,773.51 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35,481.34 / $46,773.51 / $52,480.75
| Professional | | $35,481.34 | $46,773.51 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $56,234.13
| Professional | | $43,651.58 | $43,651.58 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $45,708.82 / $81,283.05
| Facility | | $25,703.96 | $45,708.82 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,708.82 / $51,286.14 / $56,234.13
| Professional | | $45,708.82 | $51,286.14 | $56,234.13 |
- 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 / $44,668.36 / $52,480.75
| Professional | | $43,651.58 | $44,668.36 | $52,480.75 |