- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $34,961.60 / $69,354.70
| Facility | | $28,424.06 | $34,961.60 | $69,354.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $31,266.46
| Professional | | $28,424.06 | $28,424.06 | $31,266.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,946.52 / $28,424.06 / $35,721.39
| Facility | | $22,946.52 | $28,424.06 | $35,721.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $29,496.67
| Professional | | $28,424.06 | $28,424.06 | $29,496.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,496.67 / $29,496.67 / $34,677.35
| Professional | | $29,496.67 | $29,496.67 | $34,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,785.00 / $27,070.53 / $104,145.76
| Facility | | $13,785.00 | $27,070.53 | $104,145.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,714.35 / $25,930.46 / $27,207.37
| Professional | | $24,714.35 | $25,930.46 | $27,207.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,026.05 / $33,026.05 / $33,026.05
| Facility | | $33,026.05 | $33,026.05 | $33,026.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $29,987.38 / $32,178.18
| Professional | | $28,424.06 | $29,987.38 | $32,178.18 |