- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $45,708.82
| Facility | | $23,988.33 | $23,988.33 | $45,708.82 |
- 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
- $31,622.78 / $38,018.94 / $40,738.03
| Facility | | $31,622.78 | $38,018.94 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $29,512.09
| Professional | | $28,183.83 | $28,183.83 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $28,183.83 / $37,153.52
| Professional | | $60.26 | $28,183.83 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,018.94 / $47,863.01 / $97,723.72
| Facility | | $38,018.94 | $47,863.01 | $97,723.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $41,686.94
| Professional | | $31,622.78 | $31,622.78 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,197.01 / $29,512.09 / $29,512.09
| Professional | | $18,197.01 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,703.96 / $28,183.83 / $33,884.42
| Professional | | $25,703.96 | $28,183.83 | $33,884.42 |
- 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 |