- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $19,498.45
| Facility | | $18,620.87 | $18,620.87 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,197.01 / $20,892.96 / $29,512.09
| Professional | | $18,197.01 | $20,892.96 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,199.52 / $30,199.52 / $30,199.52
| Professional | | $30,199.52 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $39,810.72 / $39,810.72
| Facility | | $79.43 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $30,902.95
| Professional | | $30,902.95 | $30,902.95 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186,208.71 / $186,208.71 / $186,208.71
| Facility | | $186,208.71 | $186,208.71 | $186,208.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194,984.46 / $295,120.92 / $295,120.92
| Professional | | $194,984.46 | $295,120.92 | $295,120.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $33,884.42 / $41,686.94
| Facility | | $19,498.45 | $33,884.42 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $20,892.96 / $34,673.69
| Professional | | $18,620.87 | $20,892.96 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,162.28
| Professional | | $3,090.30 | $3,090.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $35,481.34 / $42,657.95
| Facility | | $19,952.62 | $35,481.34 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32,359.37 / $32,359.37 / $32,359.37
| Professional | | $32,359.37 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $19,952.62 / $38,018.94
| Facility | | $14,791.08 | $19,952.62 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,595.87 / $20,892.96 / $33,113.11
| Professional | | $16,595.87 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34,673.69 / $39,810.72 / $39,810.72
| Professional | | $34,673.69 | $39,810.72 | $39,810.72 |