- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $28,424.10
| Facility | | $28,424.06 | $28,424.06 | $28,424.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $34,393.10
| Professional | | $28,424.06 | $28,424.06 | $34,393.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,581.29 / $28,424.06 / $34,476.61
| Professional | | $27,581.29 | $28,424.06 | $34,476.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.06 / $32,484.64 / $56,848.12
| Facility | | $2,249.06 | $32,484.64 | $56,848.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $31,641.95 / $119,518.82
| Professional | | $28,424.06 | $31,641.95 | $119,518.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,846.00 / $35,191.69 / $45,117.56
| Facility | | $3,846.00 | $35,191.69 | $45,117.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,216.85 / $32,484.64 / $42,636.09
| Professional | | $9,216.85 | $32,484.64 | $42,636.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,105.57 / $31,105.57 / $31,105.57
| Professional | | $31,105.57 | $31,105.57 | $31,105.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $33,824.62
| Professional | | $28,424.06 | $28,424.06 | $33,824.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,105.57 / $31,105.57 / $31,105.57
| Facility | | $31,105.57 | $31,105.57 | $31,105.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,105.57 / $31,105.57 / $31,105.57
| Professional | | $31,105.57 | $31,105.57 | $31,105.57 |