- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,805.04 / $33,805.04 / $33,805.04
| Facility | | $33,805.04 | $33,805.04 | $33,805.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,218.03 / $33,805.04 / $33,805.04
| Professional | | $18,218.03 | $33,805.04 | $33,805.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,877.72 / $28,954.74 / $36,746.08
| Professional | | $26,877.72 | $28,954.74 | $36,746.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $56,172.19
| Professional | | $31,019.05 | $31,019.05 | $56,172.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,706.21 / $33,805.04 / $40,566.05
| Facility | | $27,706.21 | $33,805.04 | $40,566.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,746.08 / $36,746.08 / $36,746.08
| Professional | | $36,746.08 | $36,746.08 | $36,746.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47,082.20 / $47,082.20 / $47,082.20
| Professional | | $47,082.20 | $47,082.20 | $47,082.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,561.84 / $20,283.02 / $33,123.69
| Professional | | $16,561.84 | $20,283.02 | $33,123.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,121.22 / $185,986.30 / $185,986.30
| Facility | | $65,121.22 | $185,986.30 | $185,986.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196,622.34 / $294,263.94 / $294,263.94
| Professional | | $196,622.34 | $294,263.94 | $294,263.94 |