- 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
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $46,773.51 / $95,499.26
| Facility | | $10,964.78 | $46,773.51 | $95,499.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,113.11 / $33,113.11 / $57,543.99
| Facility | | $33,113.11 | $33,113.11 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $33,113.11
| Professional | | $28,183.83 | $28,183.83 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $27,542.29 / $50,118.72
| Facility | | $6,918.31 | $27,542.29 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $27,542.29 / $50,118.72
| Professional | | $6,918.31 | $27,542.29 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $28,183.83 / $41,686.94
| Facility | | $2,238.72 | $28,183.83 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $33,113.11 / $36,307.81
| Professional | | $79.43 | $33,113.11 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Professional | | $28,183.83 | $28,183.83 | $28,183.83 |