- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,933.26 / $26,933.26 / $26,933.26
| Facility | | $26,933.26 | $26,933.26 | $26,933.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,267.05 / $26,933.26 / $26,989.91
| Professional | | $24,267.05 | $26,933.26 | $26,989.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,492.59 / $42,492.59 / $42,492.59
| Facility | | $42,492.59 | $42,492.59 | $42,492.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,937.75 / $44,937.75 / $56,172.19
| Professional | | $44,937.75 | $44,937.75 | $56,172.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,413.12 / $45,612.95 / $182,487.33
| Facility | | $32,413.12 | $45,612.95 | $182,487.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,286.09 / $27,657.74 / $49,685.54
| Professional | | $17,286.09 | $27,657.74 | $49,685.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,368.25 / $42,492.59 / $81,122.22
| Facility | | $42,368.25 | $42,492.59 | $81,122.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42,368.25 / $42,492.59 / $52,659.26
| Professional | | $42,368.25 | $42,492.59 | $52,659.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,557.01 / $39,482.40 / $52,258.90
| Professional | | $38,557.01 | $39,482.40 | $52,258.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,776.64 / $23,186.58 / $36,137.94
| Professional | | $14,776.64 | $23,186.58 | $36,137.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,857.04 / $37,857.04 / $37,857.04
| Professional | | $37,857.04 | $37,857.04 | $37,857.04 |