- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $58,884.37 / $120,226.44
| Facility | | $28,183.83 | $58,884.37 | $120,226.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $35,481.34
| Professional | | $28,183.83 | $28,183.83 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,902.95 / $48,977.88 / $100,000.00
| Facility | | $30,902.95 | $48,977.88 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Professional | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $38,018.94
| Facility | | $26,915.35 | $26,915.35 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Professional | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $42,657.95 / $51,286.14
| Professional | | $28,183.83 | $42,657.95 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Professional | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $30,199.52
| Professional | | $28,183.83 | $28,183.83 | $30,199.52 |