- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $37,153.52 / $87,096.36
| Facility | | $28,183.83 | $37,153.52 | $87,096.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $33,113.11
| Professional | | $28,183.83 | $28,183.83 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $32,359.37
| Professional | | $28,183.83 | $28,183.83 | $32,359.37 |
- 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
- $28,183.83 / $28,183.83 / $28,183.83
| Professional | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141,253.75 / $141,253.75 / $141,253.75
| Facility | | $141,253.75 | $141,253.75 | $141,253.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120,226.44 / $120,226.44 / $120,226.44
| Professional | | $120,226.44 | $120,226.44 | $120,226.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,840.32 / $33,113.11
| Facility | | $26,915.35 | $28,840.32 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $28,183.83 / $31,622.78
| Professional | | $26,915.35 | $28,183.83 | $31,622.78 |