- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $186,208.71 / $186,208.71
| Facility | | $30,199.52 | $186,208.71 | $186,208.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $33,884.42
| Professional | | $28,183.83 | $28,183.83 | $33,884.42 |
- 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
- $10,471.29 / $28,183.83 / $70,794.58
| Facility | | $10,471.29 | $28,183.83 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $33,884.42 / $70,794.58
| Professional | | $28,183.83 | $33,884.42 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $44,668.36 / $70,794.58
| Facility | | $28,183.83 | $44,668.36 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32,359.37 / $38,904.51 / $38,904.51
| Professional | | $32,359.37 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $28,183.83 / $51,286.14
| Facility | | $2,754.23 | $28,183.83 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $36,307.81
| Professional | | $28,183.83 | $28,183.83 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $42,657.95 / $79,432.82
| Professional | | $26,915.35 | $42,657.95 | $79,432.82 |