- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $19,952.62 / $33,113.11
| Professional | | $15,488.17 | $19,952.62 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $52,480.75
| Facility | | $25,118.86 | $25,118.86 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $46,773.51
| Professional | | $26,915.35 | $26,915.35 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $63,095.73 / $63,095.73
| Facility | | $63,095.73 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $186,208.71
| Professional | | $30,902.95 | $30,902.95 | $186,208.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $38,018.94
| Facility | | $19,952.62 | $19,952.62 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $25,118.86 / $38,904.51
| Professional | | $19,952.62 | $25,118.86 | $38,904.51 |