- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $36,667.00 / $80,096.20
| Facility | | $28,424.06 | $36,667.00 | $80,096.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.10 / $34,393.10
| Professional | | $28,424.06 | $28,424.10 | $34,393.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,797.14 / $29,777.58 / $44,666.37
| Facility | | $1,797.14 | $29,777.58 | $44,666.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,288.70 / $29,777.58 / $30,373.13
| Professional | | $28,288.70 | $29,777.58 | $30,373.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,815.15 / $26,815.15 / $28,424.06
| Facility | | $26,815.15 | $26,815.15 | $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
- $25,581.65 / $28,424.06 / $32,178.18
| Professional | | $25,581.65 | $28,424.06 | $32,178.18 |