- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $20,892.96 / $27,542.29
| Professional | | $18,620.87 | $20,892.96 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218,776.16 / $524,807.46 / $954,992.59
| Facility | | $218,776.16 | $524,807.46 | $954,992.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,113.11 / $33,113.11 / $44,668.36
| Professional | | $33,113.11 | $33,113.11 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Facility | | $31,622.78 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $30,902.95
| Professional | | $30,902.95 | $30,902.95 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $38,018.94 / $44,668.36
| Facility | | $19,952.62 | $38,018.94 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $20,417.38 / $28,183.83
| Professional | | $13,182.57 | $20,417.38 | $28,183.83 |