- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.10 / $34,108.90 / $61,056.24
| Facility | | $28,424.10 | $34,108.90 | $61,056.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $34,393.10
| Professional | | $28,424.06 | $28,424.06 | $34,393.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $44,341.53 / $90,075.85
| Facility | | $28,424.06 | $44,341.53 | $90,075.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $29,496.67
| Professional | | $28,424.06 | $28,424.06 | $29,496.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,815.15 / $28,424.06 / $28,424.06
| Facility | | $26,815.15 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $29,496.67
| Professional | | $28,424.06 | $28,424.06 | $29,496.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,557.83 / $57,497.81 / $57,497.81
| Facility | | $54,557.83 | $57,497.81 | $57,497.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $32,971.91
| Professional | | $28,424.06 | $28,424.06 | $32,971.91 |