- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $25,703.96 / $33,113.11
| Professional | | $19,054.61 | $25,703.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $38,904.51 / $45,708.82
| Facility | | $37,153.52 | $38,904.51 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $38,904.51 / $38,904.51
| Professional | | $30,902.95 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102,329.30 / $144,543.98 / $346,736.85
| Facility | | $102,329.30 | $144,543.98 | $346,736.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $51,286.14 / $57,543.99
| Professional | | $44,668.36 | $51,286.14 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112,201.85 / $144,543.98 / $275,422.87
| Facility | | $112,201.85 | $144,543.98 | $275,422.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $47,863.01
| Professional | | $44,668.36 | $44,668.36 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $38,904.51 / $79,432.82
| Facility | | $27,542.29 | $38,904.51 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $19,952.62 / $46,773.51
| Professional | | $13,182.57 | $19,952.62 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $19,952.62 / $44,668.36
| Facility | | $331.13 | $19,952.62 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $20,417.38 / $46,773.51
| Professional | | $13,182.57 | $20,417.38 | $46,773.51 |