- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $151,356.12 / $151,356.12
| Facility | | $44,668.36 | $151,356.12 | $151,356.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,379.62 / $35,481.34 / $44,668.36
| Professional | | $21,379.62 | $35,481.34 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $39,810.72 / $39,810.72
| Professional | | $38,018.94 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $44,668.36 / $61,659.50
| Facility | | $31,622.78 | $44,668.36 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74,131.02 / $74,131.02 / $83,176.38
| Facility | | $74,131.02 | $74,131.02 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301,995.17 / $301,995.17 / $301,995.17
| Facility | | $301,995.17 | $301,995.17 | $301,995.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301,995.17 / $398,107.17 / $398,107.17
| Professional | | $301,995.17 | $398,107.17 | $398,107.17 |