- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,789.46 / $32,282.30 / $46,965.20
| Facility | | $23,789.46 | $32,282.30 | $46,965.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,390.08 / $23,789.46 / $23,789.46
| Professional | | $22,390.08 | $23,789.46 | $23,789.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,275.64 / $10,331.37 / $121,142.10
| Facility | | $3,275.64 | $10,331.37 | $121,142.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,275.64 / $23,614.52 / $106,352.88
| Professional | | $3,275.64 | $23,614.52 | $106,352.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,502.57 / $32,650.33 / $63,439.49
| Facility | | $28,502.57 | $32,650.33 | $63,439.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $24,228.42
| Facility | | $23,789.46 | $23,789.46 | $24,228.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $23,789.46
| Professional | | $23,789.46 | $23,789.46 | $23,789.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.00 / $9,239.00 / $38,280.90
| Facility | | $1,909.00 | $9,239.00 | $38,280.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $27,533.92
| Professional | | $23,789.46 | $23,789.46 | $27,533.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,588.22 / $121,142.10 / $121,142.10
| Facility | | $26,588.22 | $121,142.10 | $121,142.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,323.00 / $24,722.38 / $106,352.88
| Professional | | $23,323.00 | $24,722.38 | $106,352.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,323.00 / $23,789.46 / $30,210.52
| Professional | | $23,323.00 | $23,789.46 | $30,210.52 |