- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75,045.41 / $75,045.41 / $92,378.20
| Facility | | $75,045.41 | $75,045.41 | $92,378.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $29,845.26
| Professional | | $28,424.06 | $28,424.06 | $29,845.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,351.45 / $28,424.06 / $30,032.97
| Facility | | $27,351.45 | $28,424.06 | $30,032.97 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $28,424.06
| Facility | | $28,424.06 | $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
- $28,424.06 / $28,424.06 / $31,641.95
| Professional | | $28,424.06 | $28,424.06 | $31,641.95 |