- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,842.88 / $20,577.80 / $25,722.26
| Facility | | $19,842.88 | $20,577.80 | $25,722.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,447.43 / $20,577.80 / $25,722.26
| Professional | | $18,447.43 | $20,577.80 | $25,722.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,032.43 / $38,606.32 / $40,575.24
| Facility | | $24,032.43 | $38,606.32 | $40,575.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,047.25 / $2,476.46 / $2,476.46
| Professional | | $2,047.25 | $2,476.46 | $2,476.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,954.74 / $54,267.68 / $62,416.55
| Facility | | $28,954.74 | $54,267.68 | $62,416.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,676.00 / $48,257.90 / $63,700.43
| Professional | | $36,676.00 | $48,257.90 | $63,700.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,241.78 / $45,241.78 / $45,241.78
| Facility | | $45,241.78 | $45,241.78 | $45,241.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $187,946.36
| Professional | | $31,019.05 | $31,019.05 | $187,946.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,522.02 / $20,283.02 / $30,885.06
| Professional | | $13,522.02 | $20,283.02 | $30,885.06 |