- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,998.00 / $50,964.30 / $85,272.20
| Facility | | $33,998.00 | $50,964.30 | $85,272.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,708.30 / $37,519.80
| Professional | | $28,424.06 | $28,708.30 | $37,519.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,583.85 / $88,056.19 / $148,771.53
| Facility | | $23,583.85 | $88,056.19 | $148,771.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,204.27 / $27,287.10 / $29,674.72
| Professional | | $26,204.27 | $27,287.10 | $29,674.72 |
- 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 / $28,424.06
| Professional | | $28,424.06 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $30,697.98 / $48,605.14
| Facility | | $2,000.00 | $30,697.98 | $48,605.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $119,518.82
| Professional | | $28,424.06 | $28,424.06 | $119,518.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $30,129.50
| Professional | | $28,424.06 | $28,424.06 | $30,129.50 |