- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $54,954.09 / $91,201.08
| Facility | | $29,512.09 | $54,954.09 | $91,201.08 |
- 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
- $28,840.32 / $60,255.96 / $125,892.54
| Facility | | $28,840.32 | $60,255.96 | $125,892.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,542.29 / $28,840.32 / $30,199.52
| Professional | | $27,542.29 | $28,840.32 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $30,902.95
| Professional | | $28,183.83 | $28,183.83 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $42,657.95 / $91,201.08
| Facility | | $26,915.35 | $42,657.95 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,840.32 / $37,153.52
| Professional | | $28,183.83 | $28,840.32 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $30,902.95
| Professional | | $28,183.83 | $28,183.83 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,183.83 / $28,183.83
| Facility | | $26,915.35 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $30,199.52 / $33,884.42
| Professional | | $26,915.35 | $30,199.52 | $33,884.42 |