- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,902.95 / $43,651.58 / $97,723.72
| Facility | | $30,902.95 | $43,651.58 | $97,723.72 |
- 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
- $14,454.40 / $33,113.11 / $56,234.13
| Facility | | $14,454.40 | $33,113.11 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,442.29 / $33,884.42 / $45,708.82
| Professional | | $23,442.29 | $33,884.42 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $33,884.42 / $40,738.03
| Facility | | $28,183.83 | $33,884.42 | $40,738.03 |
- 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 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,183.83 / $40,738.03
| Professional | | $26,915.35 | $28,183.83 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $28,183.83 / $37,153.52
| Facility | | $2,454.71 | $28,183.83 | $37,153.52 |
- 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
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,183.83 / $30,199.52
| Professional | | $26,915.35 | $28,183.83 | $30,199.52 |