- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,497.08 / $28,127.67 / $39,949.44
| Facility | | $26,497.08 | $28,127.67 | $39,949.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,464.72 / $28,127.67 / $40,764.74
| Professional | | $21,464.72 | $28,127.67 | $40,764.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,672.53 / $72,899.58 / $102,470.33
| Facility | | $42,672.53 | $72,899.58 | $102,470.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,101.16 / $34,808.90 / $34,808.90
| Professional | | $29,101.16 | $34,808.90 | $34,808.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $30,391.12
| Facility | | $30,391.12 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $30,391.12
| Professional | | $22,185.52 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,040.44 / $24,458.84 / $31,023.06
| Professional | | $13,040.44 | $24,458.84 | $31,023.06 |