- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,992.50 / $32,178.20 / $125,066.00
| Facility | | $28,992.50 | $32,178.20 | $125,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $30,697.98 / $39,793.68
| Professional | | $28,424.06 | $30,697.98 | $39,793.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,195.22 / $30,136.91 / $31,723.06
| Facility | | $19,195.22 | $30,136.91 | $31,723.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,390.48 / $29,390.48 / $29,390.48
| Professional | | $29,390.48 | $29,390.48 | $29,390.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,815.15 / $28,424.06 / $28,461.00
| Facility | | $26,815.15 | $28,424.06 | $28,461.00 |
- 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 / $29,186.56 / $42,069.03
| Facility | | $28,424.06 | $29,186.56 | $42,069.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $31,641.95 / $119,518.82
| Professional | | $28,424.06 | $31,641.95 | $119,518.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $30,129.50 / $33,824.62
| Professional | | $28,424.06 | $30,129.50 | $33,824.62 |