- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.10 / $48,320.90
| Facility | | $28,424.06 | $28,424.10 | $48,320.90 |
- 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
- $32,178.18 / $33,518.94 / $56,848.12
| Facility | | $32,178.18 | $33,518.94 | $56,848.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,781.46 / $28,424.06 / $28,424.06
| Professional | | $25,781.46 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $34,108.87 / $45,478.50
| Facility | | $28,424.06 | $34,108.87 | $45,478.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $31,266.47 / $43,773.05
| Professional | | $28,424.06 | $31,266.47 | $43,773.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,351.45 / $27,351.45 / $28,424.06
| Facility | | $27,351.45 | $27,351.45 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,450.84 / $28,424.06 / $38,727.78
| Professional | | $7,450.84 | $28,424.06 | $38,727.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,070.53 / $28,153.35 / $35,191.69
| Professional | | $27,070.53 | $28,153.35 | $35,191.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $29,276.78 / $31,641.95
| Professional | | $28,424.06 | $29,276.78 | $31,641.95 |