- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,054.61
| Facility | | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $20,892.96 / $28,840.32
| Professional | | $18,620.87 | $20,892.96 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $39,810.72 / $48,977.88
| Facility | | $1,905.46 | $39,810.72 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,454.71 / $53,703.18
| Professional | | $1,905.46 | $2,454.71 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,904.51 / $47,863.01 / $57,543.99
| Facility | | $38,904.51 | $47,863.01 | $57,543.99 |
- 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
- $30,902.95 / $30,902.95 / $42,657.95
| Professional | | $30,902.95 | $30,902.95 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $30,902.95 / $33,113.11
| Facility | | $16,595.87 | $30,902.95 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $20,417.38 / $33,113.11
| Professional | | $13,182.57 | $20,417.38 | $33,113.11 |