- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $28,424.06
| Facility | | $28,424.06 | $28,424.06 | $28,424.06 |
- 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
- $22,759.21 / $27,070.53 / $52,298.70
| Facility | | $22,759.21 | $27,070.53 | $52,298.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,876.21 / $28,949.90 / $29,845.26
| Professional | | $23,876.21 | $28,949.90 | $29,845.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,052.26 / $43,703.09 / $88,560.72
| Facility | | $35,052.26 | $43,703.09 | $88,560.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,857.10 / $30,339.42 / $35,028.24
| Professional | | $27,857.10 | $30,339.42 | $35,028.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,068.18 / $42,277.45 / $96,380.05
| Facility | | $33,068.18 | $42,277.45 | $96,380.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,581.29 / $27,581.29 / $29,420.04
| Professional | | $27,581.29 | $27,581.29 | $29,420.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,886.74 / $28,424.06 / $51,163.31
| Facility | | $2,886.74 | $28,424.06 | $51,163.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $31,641.95 / $73,277.80
| Professional | | $28,424.06 | $31,641.95 | $73,277.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $30,129.50 / $54,378.35
| Professional | | $28,424.06 | $30,129.50 | $54,378.35 |