- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,561.02 / $41,214.90 / $76,813.20
| Facility | | $29,561.02 | $41,214.90 | $76,813.20 |
- 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 / $43,663.84 / $83,003.94
| Facility | | $28,424.06 | $43,663.84 | $83,003.94 |
- 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
- $28,424.06 / $28,424.06 / $28,424.06
| Facility | | $28,424.06 | $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
- Professional
- Modifier
- Low / Median / High Price
- $29,496.67 / $29,496.67 / $33,982.83
| Professional | | $29,496.67 | $29,496.67 | $33,982.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,002.86 / $28,424.06 / $31,266.47
| Professional | | $27,002.86 | $28,424.06 | $31,266.47 |