- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,568.13 / $15,568.13 / $60,248.70
| Facility | | $15,568.13 | $15,568.13 | $60,248.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,568.13 / $18,002.73 / $20,957.91
| Professional | | $15,568.13 | $18,002.73 | $20,957.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,804.37 / $37,828.21 / $37,828.21
| Professional | | $28,804.37 | $37,828.21 | $37,828.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,235.19 / $39,235.19 / $45,241.78
| Facility | | $39,235.19 | $39,235.19 | $45,241.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $44,937.75
| Professional | | $31,019.05 | $31,019.05 | $44,937.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,096.37 / $39,235.19 / $74,546.86
| Professional | | $36,096.37 | $39,235.19 | $74,546.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,568.13 / $15,568.13 / $60,248.70
| Facility | | $15,568.13 | $15,568.13 | $60,248.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,568.13 / $18,218.03 / $27,559.56
| Professional | | $15,568.13 | $18,218.03 | $27,559.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63,558.10 / $77,300.30 / $77,300.30
| Professional | | $63,558.10 | $77,300.30 | $77,300.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,235.19 / $39,235.19 / $45,241.78
| Facility | | $39,235.19 | $39,235.19 | $45,241.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $45,387.13
| Professional | | $31,019.05 | $31,019.05 | $45,387.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,005.46 / $36,005.46 / $36,436.06
| Facility | | $36,005.46 | $36,005.46 | $36,436.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,005.46 / $36,005.46 / $37,344.65
| Professional | | $36,005.46 | $36,005.46 | $37,344.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,218.03 / $21,530.40 / $39,235.19
| Professional | | $18,218.03 | $21,530.40 | $39,235.19 |