- 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 / $50,118.72
| Professional | | $43,651.58 | $43,651.58 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,286.14 / $60,255.96 / $60,255.96
| Professional | | $51,286.14 | $60,255.96 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $40,738.03
| Facility | | $40,738.03 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $61,659.50
| Professional | | $43,651.58 | $43,651.58 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $91,201.08
| Facility | | $44,668.36 | $44,668.36 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $45,708.82
| Professional | | $43,651.58 | $43,651.58 | $45,708.82 |