- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,577.83 / $40,515.23 / $40,515.23
| Facility | | $35,577.83 | $40,515.23 | $40,515.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,259.07 / $25,952.62 / $40,881.19
| Professional | | $20,259.07 | $25,952.62 | $40,881.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $52,946.39
| Facility | | $31,290.51 | $31,290.51 | $52,946.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,290.51 / $56,076.38 / $70,095.47
| Professional | | $31,290.51 | $56,076.38 | $70,095.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,813.80 / $48,370.76 / $55,384.99
| Professional | | $45,813.80 | $48,370.76 | $55,384.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,695.25 / $62,573.00 / $225,247.51
| Facility | | $30,695.25 | $62,573.00 | $225,247.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,010.70 / $30,113.83 / $63,082.33
| Professional | | $23,010.70 | $30,113.83 | $63,082.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,791.47 / $52,946.39 / $65,643.88
| Facility | | $52,791.47 | $52,946.39 | $65,643.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,363.37 / $61,848.63 / $101,179.47
| Professional | | $43,363.37 | $61,848.63 | $101,179.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,557.44 / $25,642.46 / $56,634.03
| Professional | | $21,557.44 | $25,642.46 | $56,634.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,170.42 / $47,170.42 / $47,170.42
| Facility | | $47,170.42 | $47,170.42 | $47,170.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,264.62 / $47,170.42 / $47,170.42
| Professional | | $37,264.62 | $47,170.42 | $47,170.42 |