- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,379.62 / $28,840.32 / $38,018.94
| Professional | | $21,379.62 | $28,840.32 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47,863.01 / $91,201.08 / $165,958.69
| Professional | | $47,863.01 | $91,201.08 | $165,958.69 |
- 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 / $67,608.30
| Professional | | $38,018.94 | $38,018.94 | $67,608.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $38,018.94 / $100,000.00
| Facility | | $27,542.29 | $38,018.94 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $52,480.75 / $100,000.00
| Facility | | $27,542.29 | $52,480.75 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,608.30 / $301,995.17 / $301,995.17
| Professional | | $67,608.30 | $301,995.17 | $301,995.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $85.11
| Professional | | $50.12 | $54.95 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,286.14 / $112,201.85 / $208,929.61
| Professional | | $51,286.14 | $112,201.85 | $208,929.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $301,995.17
| Facility | | $39,810.72 | $39,810.72 | $301,995.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $67,608.30 / $301,995.17
| Professional | | $38,018.94 | $67,608.30 | $301,995.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $45,708.82 / $45,708.82
| Facility | | $45,708.82 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46,773.51 / $54,954.09 / $58,884.37
| Professional | | $46,773.51 | $54,954.09 | $58,884.37 |