- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109,846.87 / $109,846.87 / $109,846.87
| Professional | | $109,846.87 | $109,846.87 | $109,846.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $69,162.84
| Professional | | $69,162.84 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157,081.01 / $157,081.01 / $157,081.01
| Facility | | $157,081.01 | $157,081.01 | $157,081.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48,209.84 / $48,209.84 / $68,871.20
| Professional | | $48,209.84 | $48,209.84 | $68,871.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108,962.92 / $108,962.92 / $171,227.45
| Facility | | $108,962.92 | $108,962.92 | $171,227.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103,774.20 / $148,248.85 / $244,610.62
| Facility | | $103,774.20 | $148,248.85 | $244,610.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48,209.84 / $68,871.20 / $69,162.84
| Professional | | $48,209.84 | $68,871.20 | $69,162.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $67,806.71
| Professional | | $67,806.71 | $67,806.71 | $67,806.71 |