- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,254.12 / $27,254.12 / $42,584.57
| Facility | | $27,254.12 | $27,254.12 | $42,584.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,583.49 / $39,624.85 / $42,584.57
| Professional | | $25,583.49 | $39,624.85 | $42,584.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,686.66 / $37,686.66 / $37,686.66
| Facility | | $37,686.66 | $37,686.66 | $37,686.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,686.66 / $37,686.66 / $37,686.66
| Professional | | $37,686.66 | $37,686.66 | $37,686.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $31,290.51
| Facility | | $31,290.51 | $31,290.51 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $22,842.07 / $31,290.51
| Professional | | $22,842.07 | $22,842.07 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,371.62 / $24,262.36 / $33,219.35
| Professional | | $14,371.62 | $24,262.36 | $33,219.35 |