- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,178.22 / $39,350.65 / $39,350.65
| Facility | | $31,178.22 | $39,350.65 | $39,350.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,333.15 / $23,548.73 / $34,332.26
| Professional | | $16,333.15 | $23,548.73 | $34,332.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $47,710.27
| Facility | | $30,391.12 | $30,391.12 | $47,710.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,391.12 / $54,464.63 / $68,080.78
| Professional | | $30,391.12 | $54,464.63 | $68,080.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,370.59 / $39,208.42 / $46,980.38
| Professional | | $28,370.59 | $39,208.42 | $46,980.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,659.65 / $56,384.86 / $202,594.16
| Facility | | $27,659.65 | $56,384.86 | $202,594.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,735.06 / $27,324.50 / $59,260.10
| Professional | | $20,735.06 | $27,324.50 | $59,260.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,570.68 / $47,710.27 / $59,563.55
| Facility | | $47,570.68 | $47,710.27 | $59,563.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39,074.94 / $55,732.13 / $91,173.36
| Professional | | $39,074.94 | $55,732.13 | $91,173.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,735.06 / $24,633.53 / $56,843.82
| Professional | | $20,735.06 | $24,633.53 | $56,843.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,505.51 / $42,505.51 / $42,505.51
| Facility | | $42,505.51 | $42,505.51 | $42,505.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,579.35 / $42,505.51 / $42,505.51
| Professional | | $33,579.35 | $42,505.51 | $42,505.51 |