- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,829.99 / $26,829.99 / $26,829.99
| Facility | | $26,829.99 | $26,829.99 | $26,829.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,957.91 / $26,829.99 / $26,829.99
| Professional | | $21,957.91 | $26,829.99 | $26,829.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71,107.74 / $141,674.03 / $258,035.04
| Facility | | $71,107.74 | $141,674.03 | $258,035.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,631.36 / $46,980.38 / $63,423.51
| Professional | | $44,631.36 | $46,980.38 | $63,423.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,485.47 / $27,239.69 / $30,537.25
| Facility | | $25,485.47 | $27,239.69 | $30,537.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,584.30 / $37,584.30 / $37,584.30
| Professional | | $37,584.30 | $37,584.30 | $37,584.30 |
- 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
- $30,391.12 / $30,391.12 / $54,464.63
| Professional | | $30,391.12 | $30,391.12 | $54,464.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,829.99 / $33,950.22 / $33,950.22
| Facility | | $26,829.99 | $33,950.22 | $33,950.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,829.99 / $33,950.22 / $49,329.39
| Professional | | $26,829.99 | $33,950.22 | $49,329.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,550.65 / $34,765.48 / $39,980.30
| Professional | | $29,550.65 | $34,765.48 | $39,980.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,679.22 / $22,459.63 / $32,601.09
| Professional | | $17,679.22 | $22,459.63 | $32,601.09 |