- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $48,977.88 / $83,176.38
| Facility | | $31,622.78 | $48,977.88 | $83,176.38 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $43,651.58 / $67,608.30
| Facility | | $31,622.78 | $43,651.58 | $67,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $29,512.09
| Professional | | $28,183.83 | $28,183.83 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | | $28,183.83 | $28,183.83 | $28,183.83 |
- 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
- $29,512.09 / $29,512.09 / $33,884.42
| Professional | | $29,512.09 | $29,512.09 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,183.83 / $31,622.78
| Professional | | $26,915.35 | $28,183.83 | $31,622.78 |