- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,453.80 / $27,453.80 / $27,453.80
| Facility | | $27,453.80 | $27,453.80 | $27,453.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,453.80 / $32,344.32 / $37,937.89
| Professional | | $27,453.80 | $32,344.32 | $37,937.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,342.19 / $88,058.74 / $177,863.05
| Professional | | $46,342.19 | $88,058.74 | $177,863.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,437.90 / $38,437.90 / $67,831.58
| Professional | | $38,437.90 | $38,437.90 | $67,831.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,453.80 / $37,937.89 / $99,655.90
| Facility | | $27,453.80 | $37,937.89 | $99,655.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,453.80 / $37,937.89 / $99,655.90
| Facility | | $27,453.80 | $37,937.89 | $99,655.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,831.58 / $303,364.75 / $303,364.75
| Professional | | $67,831.58 | $303,364.75 | $303,364.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $55.00 / $85.00
| Professional | | $50.00 | $55.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,453.80 / $37,937.89 / $99,655.90
| Facility | | $27,453.80 | $37,937.89 | $99,655.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,726.74 / $107,829.28 / $158,759.15
| Professional | | $51,726.74 | $107,829.28 | $158,759.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247,449.59 / $247,449.59 / $247,449.59
| Facility | | $247,449.59 | $247,449.59 | $247,449.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,437.90 / $200,409.84 / $303,364.75
| Professional | | $38,437.90 | $200,409.84 | $303,364.75 |