- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,939.64 / $22,939.64 / $36,329.08
| Facility | | $22,939.64 | $22,939.64 | $36,329.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,549.43 / $22,939.64 / $29,310.97
| Professional | | $20,549.43 | $22,939.64 | $29,310.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,114.58 / $51,678.42 / $133,894.07
| Facility | | $44,114.58 | $51,678.42 | $133,894.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,537.37 / $23,953.47 / $61,074.49
| Professional | | $23,537.37 | $23,953.47 | $61,074.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,430.41 / $46,980.38 / $63,423.51
| Facility | | $31,430.41 | $46,980.38 | $63,423.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,537.25 / $42,282.34 / $100,594.39
| Professional | | $30,537.25 | $42,282.34 | $100,594.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $49,782.75
| Facility | | $30,391.12 | $30,391.12 | $49,782.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $22,185.52 / $38,824.66
| Professional | | $22,185.52 | $22,185.52 | $38,824.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $30,391.12
| Facility | | $30,391.12 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $30,391.12
| Professional | | $22,185.52 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,625.33 / $23,438.00 / $30,142.37
| Professional | | $15,625.33 | $23,438.00 | $30,142.37 |