- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123,026.88 / $123,026.88 / $123,026.88
| Facility | | $123,026.88 | $123,026.88 | $123,026.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $50,118.72
| Professional | | $43,651.58 | $43,651.58 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $51,286.14 / $51,286.14
| Facility | | $51,286.14 | $51,286.14 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $51,286.14 / $51,286.14
| Facility | | $40,738.03 | $51,286.14 | $51,286.14 |
- 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
- $18,620.87 / $48,977.88 / $48,977.88
| Professional | | $18,620.87 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $45,708.82 / $51,286.14
| Professional | | $40,738.03 | $45,708.82 | $51,286.14 |