- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,987.60 / $29,387.00 / $78,085.39
| Facility | | $27,987.60 | $29,387.00 | $78,085.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,669.96 / $27,987.60 / $27,987.60
| Professional | | $22,669.96 | $27,987.60 | $27,987.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,188.84 / $25,188.84 / $37,783.26
| Facility | | $25,188.84 | $25,188.84 | $37,783.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,929.40 / $25,188.84 / $25,692.62
| Professional | | $23,929.40 | $25,188.84 | $25,692.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $23,789.46
| Facility | | $23,789.46 | $23,789.46 | $23,789.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $23,789.46
| Professional | | $23,789.46 | $23,789.46 | $23,789.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,457.16 / $23,323.00 / $27,987.60
| Professional | | $21,457.16 | $23,323.00 | $27,987.60 |