- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,182.43 / $29,182.43 / $59,225.40
| Facility | | $29,182.43 | $29,182.43 | $59,225.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,714.66 / $29,182.43 / $29,182.43
| Professional | | $18,714.66 | $29,182.43 | $29,182.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,718.51 / $58,160.02 / $71,625.64
| Facility | | $35,718.51 | $58,160.02 | $71,625.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,348.80 / $29,406.32 / $29,406.32
| Professional | | $22,348.80 | $29,406.32 | $29,406.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,253.46 / $30,391.12 / $30,391.12
| Facility | | $24,253.46 | $30,391.12 | $30,391.12 |
- 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
- $12,628.02 / $29,182.43 / $46,117.83
| Facility | | $12,628.02 | $29,182.43 | $46,117.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,046.00 / $22,046.00 / $27,508.00
| Professional | | $22,046.00 | $22,046.00 | $27,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,775.20 / $51,775.20 / $79,606.70
| Professional | | $51,775.20 | $51,775.20 | $79,606.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,300.55 / $19,643.58 / $30,687.34
| Professional | | $16,300.55 | $19,643.58 | $30,687.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78,927.03 / $206,563.77 / $206,563.77
| Facility | | $78,927.03 | $206,563.77 | $206,563.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242,681.77 / $242,681.77 / $323,594.78
| Professional | | $242,681.77 | $242,681.77 | $323,594.78 |