- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.10 / $28,424.10 / $32,867.48
| Facility | | $28,424.10 | $28,424.10 | $32,867.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $42,351.90
| Professional | | $28,424.06 | $28,424.06 | $42,351.90 |
- 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
- $27,070.53 / $27,070.53 / $27,351.45
| Facility | | $27,070.53 | $27,070.53 | $27,351.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $33,518.94
| Professional | | $28,424.06 | $28,424.06 | $33,518.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,160.45 / $28,424.06 / $28,960.36
| Professional | | $24,160.45 | $28,424.06 | $28,960.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $31,641.95 / $33,921.26
| Professional | | $28,424.06 | $31,641.95 | $33,921.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,070.53 / $27,070.53 / $38,372.48
| Professional | | $27,070.53 | $27,070.53 | $38,372.48 |