- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $46,773.51 / $79,432.82
| Facility | | $43,651.58 | $46,773.51 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $52,480.75
| Professional | | $43,651.58 | $43,651.58 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $43,651.58
| Facility | | $40,738.03 | $40,738.03 | $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
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $48,977.88 / $74,131.02
| Facility | | $37,153.52 | $48,977.88 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $45,708.82 / $199,526.23
| Professional | | $43,651.58 | $45,708.82 | $199,526.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $44,668.36
| Facility | | $43,651.58 | $43,651.58 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,686.94 / $45,708.82 / $50,118.72
| Professional | | $41,686.94 | $45,708.82 | $50,118.72 |