- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $13,803.84 / $22,387.21
| Professional | | $12,022.64 | $13,803.84 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $23,442.29
| Professional | | $21,877.62 | $21,877.62 | $23,442.29 |
- 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
- $25,118.86 / $25,118.86 / $33,113.11
| Professional | | $25,118.86 | $25,118.86 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $23,988.33
| Facility | | $16,218.10 | $16,218.10 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $11,748.98 / $16,218.10
| Professional | | $10,964.78 | $11,748.98 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Professional | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $30,199.52 / $35,481.34
| Facility | | $16,982.44 | $30,199.52 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,803.84 / $19,952.62
| Professional | | $8,709.64 | $13,803.84 | $19,952.62 |