- 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
- $15,488.17 / $24,547.09 / $33,113.11
| Professional | | $15,488.17 | $24,547.09 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $56,234.13
| Professional | | $44,668.36 | $44,668.36 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,359.37 / $42,657.95 / $74,131.02
| Facility | | $32,359.37 | $42,657.95 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $27,542.29 / $194,984.46
| Professional | | $17,378.01 | $27,542.29 | $194,984.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42,657.95 / $42,657.95 / $42,657.95
| Professional | | $42,657.95 | $42,657.95 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,153.52 / $40,738.03 / $52,480.75
| Professional | | $37,153.52 | $40,738.03 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $23,442.29 / $41,686.94
| Professional | | $16,982.44 | $23,442.29 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $38,018.94 / $38,018.94
| Professional | | $38,018.94 | $38,018.94 | $38,018.94 |