- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,664.30 / $21,069.43 / $21,069.43
| Facility | | $20,664.30 | $21,069.43 | $21,069.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,627.87 / $21,069.43 / $36,196.87
| Professional | | $20,627.87 | $21,069.43 | $36,196.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,975.86 / $43,769.51 / $43,769.51
| Professional | | $28,975.86 | $43,769.51 | $43,769.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $31,290.51
| Facility | | $31,290.51 | $31,290.51 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $22,842.07 / $31,290.51
| Professional | | $22,842.07 | $22,842.07 | $31,290.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,654.27 / $225,247.51 / $225,247.51
| Facility | | $65,654.27 | $225,247.51 | $225,247.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243,527.58 / $243,527.58 / $354,084.53
| Professional | | $243,527.58 | $243,527.58 | $354,084.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,174.91 / $24,262.36 / $32,480.45
| Professional | | $16,174.91 | $24,262.36 | $32,480.45 |