- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $79,432.82 / $85,113.80
| Facility | | $43,651.58 | $79,432.82 | $85,113.80 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $51,286.14
| Professional | | $44,668.36 | $44,668.36 | $51,286.14 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $223,872.11 / $223,872.11 / $223,872.11
| Facility | | $223,872.11 | $223,872.11 | $223,872.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199,526.23 / $199,526.23 / $199,526.23
| Professional | | $199,526.23 | $199,526.23 | $199,526.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $47,863.01 / $54,954.09
| Facility | | $44,668.36 | $47,863.01 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $43,651.58 / $51,286.14
| Professional | | $40,738.03 | $43,651.58 | $51,286.14 |