- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.60 / $20,417.38 / $47,863.01
| Facility | | $16.60 | $20,417.38 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $29,512.09 / $47,863.01
| Professional | | $20,417.38 | $29,512.09 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42,657.95 / $66,069.34 / $69,183.10
| Professional | | $42,657.95 | $66,069.34 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Professional | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $38,018.94 / $39,810.72
| Professional | | $38,018.94 | $38,018.94 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $58,884.37 / $245,470.89
| Facility | | $26,302.68 | $58,884.37 | $245,470.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301,995.17 / $301,995.17 / $301,995.17
| Professional | | $301,995.17 | $301,995.17 | $301,995.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74,131.02 / $74,131.02 / $74,131.02
| Facility | | $74,131.02 | $74,131.02 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,773.51 / $46,773.51 / $46,773.51
| Professional | | $46,773.51 | $46,773.51 | $46,773.51 |