- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $47,863.01 / $87,096.36
| Facility | | $43,651.58 | $47,863.01 | $87,096.36 |
- 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
- $51,286.14 / $64,565.42 / $91,201.08
| Facility | | $51,286.14 | $64,565.42 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $46,773.51
| Professional | | $43,651.58 | $43,651.58 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $43,651.58 / $43,651.58
| Facility | | $40,738.03 | $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
- $40,738.03 / $40,738.03 / $47,863.01
| Professional | | $40,738.03 | $40,738.03 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,686.94 / $43,651.58 / $47,863.01
| Professional | | $41,686.94 | $43,651.58 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $69,183.10 / $85,113.80
| Facility | | $51,286.14 | $69,183.10 | $85,113.80 |