- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,810.53 / $19,179.36 / $19,548.20
| Facility | | $18,810.53 | $19,179.36 | $19,548.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,072.86 / $19,548.20 / $28,804.37
| Professional | | $18,072.86 | $19,548.20 | $28,804.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,705.20 / $22,705.20 / $22,705.20
| Professional | | $22,705.20 | $22,705.20 | $22,705.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,750.60 / $38,750.60 / $38,750.60
| Facility | | $38,750.60 | $38,750.60 | $38,750.60 |
- 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 / $31,019.05
| Professional | | $31,019.05 | $31,019.05 | $31,019.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78,688.14 / $182,487.33 / $185,986.30
| Facility | | $78,688.14 | $182,487.33 | $185,986.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196,622.34 / $196,622.34 / $294,263.94
| Professional | | $196,622.34 | $196,622.34 | $294,263.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,842.89 / $32,938.01 / $38,750.60
| Facility | | $19,842.89 | $32,938.01 | $38,750.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,706.21 / $35,650.55 / $38,750.60
| Professional | | $27,706.21 | $35,650.55 | $38,750.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,210.34 / $29,062.95 / $38,750.60
| Facility | | $20,210.34 | $29,062.95 | $38,750.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $36,746.08
| Professional | | $31,019.05 | $31,019.05 | $36,746.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,561.84 / $20,922.45 / $33,123.69
| Professional | | $16,561.84 | $20,922.45 | $33,123.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34,733.21 / $38,750.60 / $54,000.00
| Professional | | $34,733.21 | $38,750.60 | $54,000.00 |