- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.10 / $50,400.74 / $65,460.60
| Facility | | $28,424.10 | $50,400.74 | $65,460.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,708.30 / $51,660.50
| Professional | | $28,424.06 | $28,708.30 | $51,660.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,008.01 / $29,845.26 / $90,672.75
| Facility | | $26,008.01 | $29,845.26 | $90,672.75 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $27,070.53 / $28,424.06 / $28,424.06
| Facility | | $27,070.53 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $28,424.06
| Professional | | $28,424.06 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,707.89 / $30,837.42 / $32,178.18
| Professional | | $26,707.89 | $30,837.42 | $32,178.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,917.81 / $29,917.81 / $29,917.81
| Facility | | $29,917.81 | $29,917.81 | $29,917.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $28,424.06
| Professional | | $28,424.06 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $30,129.50
| Professional | | $28,424.06 | $28,424.06 | $30,129.50 |