- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $15,135.61
| Facility | | $15,135.61 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $24,547.09 / $42,657.95
| Professional | | $20,417.38 | $24,547.09 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,863.01 / $47,863.01 / $50,118.72
| Facility | | $47,863.01 | $47,863.01 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $34,673.69
| Professional | | $28,183.83 | $28,183.83 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $31,622.78 / $37,153.52
| Facility | | $22,908.68 | $31,622.78 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $31,622.78
| Professional | | $22,908.68 | $22,908.68 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42,657.95 / $47,863.01 / $50,118.72
| Professional | | $42,657.95 | $47,863.01 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $28,183.83 / $32,359.37
| Facility | | $16,218.10 | $28,183.83 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $30,902.95 / $43,651.58
| Professional | | $19,952.62 | $30,902.95 | $43,651.58 |