- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $29,512.09 / $46,773.51
| Facility | | $28,183.83 | $29,512.09 | $46,773.51 |
- 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
- $28,183.83 / $45,708.82 / $154,881.66
| Facility | | $28,183.83 | $45,708.82 | $154,881.66 |
- 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
- $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
- $26,915.35 / $26,915.35 / $28,183.83
| Facility | | $26,915.35 | $26,915.35 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $33,113.11
| Professional | | $28,183.83 | $28,183.83 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $28,183.83 / $45,708.82
| Professional | | $6,760.83 | $28,183.83 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $28,183.83 / $48,977.88
| Professional | | $30.20 | $28,183.83 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $52,480.75 / $74,131.02
| Facility | | $26,915.35 | $52,480.75 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,840.32 / $33,884.42
| Professional | | $26,915.35 | $28,840.32 | $33,884.42 |