- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $46,773.51
| Facility | | $20,892.96 | $20,892.96 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $21,379.62 / $34,673.69
| Professional | | $19,054.61 | $21,379.62 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $93,325.43 / $144,543.98
| Facility | | $39,810.72 | $93,325.43 | $144,543.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,286.14 / $371,535.23 / $371,535.23
| Professional | | $51,286.14 | $371,535.23 | $371,535.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,113.11 / $33,113.11 / $33,113.11
| Facility | | $33,113.11 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,113.11 / $33,113.11 / $33,113.11
| Professional | | $33,113.11 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $63,095.73 / $63,095.73
| Facility | | $63,095.73 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $41,686.94
| Professional | | $30,902.95 | $30,902.95 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,199.52 / $39,810.72 / $43,651.58
| Professional | | $30,199.52 | $39,810.72 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $19,952.62 / $30,902.95
| Facility | | $14,791.08 | $19,952.62 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $20,417.38 / $38,904.51
| Professional | | $13,489.63 | $20,417.38 | $38,904.51 |