- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $87,096.36 / $109,647.82
| Facility | | $43,651.58 | $87,096.36 | $109,647.82 |
- 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
- $43,651.58 / $45,708.82 / $138,038.43
| Facility | | $43,651.58 | $45,708.82 | $138,038.43 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $45,708.82
| Facility | | $43,651.58 | $43,651.58 | $45,708.82 |
- 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
- $46,773.51 / $46,773.51 / $53,703.18
| Professional | | $46,773.51 | $46,773.51 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $42,657.95
| Professional | | $40,738.03 | $40,738.03 | $42,657.95 |
- 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 |