- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $33,113.11 / $104,712.85
| Facility | | $28,183.83 | $33,113.11 | $104,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,840.32 / $39,810.72
| Professional | | $28,183.83 | $28,840.32 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $29,512.09 / $79,432.82
| Facility | | $28,183.83 | $29,512.09 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $35,481.34
| Professional | | $28,183.83 | $28,183.83 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Professional | | $31,622.78 | $31,622.78 | $31,622.78 |
- 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
- $28,183.83 / $28,183.83 / $32,359.37
| Professional | | $28,183.83 | $28,183.83 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $31,622.78 / $47,863.01
| Facility | | $26,302.68 | $31,622.78 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,703.96 / $30,199.52 / $120,226.44
| Professional | | $25,703.96 | $30,199.52 | $120,226.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $33,113.11 / $36,307.81
| Facility | | $28,183.83 | $33,113.11 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,703.96 / $28,183.83 / $32,359.37
| Professional | | $25,703.96 | $28,183.83 | $32,359.37 |