- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,739.45 / $19,739.45 / $19,739.45
| Facility | | $19,739.45 | $19,739.45 | $19,739.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,739.45 / $19,739.45 / $32,958.98
| Professional | | $19,739.45 | $19,739.45 | $32,958.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,153.75 / $76,180.92 / $206,563.77
| Facility | | $24,153.75 | $76,180.92 | $206,563.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,621.32 / $31,023.06 / $44,119.09
| Professional | | $19,621.32 | $31,023.06 | $44,119.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,951.67 / $58,338.72 / $75,129.25
| Facility | | $47,951.67 | $58,338.72 | $75,129.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,582.92 / $40,085.40 / $40,085.40
| Professional | | $29,582.92 | $40,085.40 | $40,085.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,131.79 / $30,391.12 / $31,672.16
| Facility | | $26,131.79 | $30,391.12 | $31,672.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $54,464.63
| Professional | | $22,185.52 | $30,391.12 | $54,464.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,578.56 / $36,578.56 / $38,407.49
| Professional | | $36,578.56 | $36,578.56 | $38,407.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,910.33 / $24,910.33 / $24,910.33
| Professional | | $24,910.33 | $24,910.33 | $24,910.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95,370.17 / $206,563.77 / $206,563.77
| Facility | | $95,370.17 | $206,563.77 | $206,563.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,647.64 / $24,149.32 / $44,119.09
| Professional | | $17,647.64 | $24,149.32 | $44,119.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,673.33 / $24,149.32 / $43,145.97
| Professional | | $18,673.33 | $24,149.32 | $43,145.97 |