- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,627.87 / $20,627.87 / $20,627.87
| Facility | | $20,627.87 | $20,627.87 | $20,627.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,627.87 / $21,756.03 / $37,567.32
| Professional | | $20,627.87 | $21,756.03 | $37,567.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,240.23 / $126,087.09 / $225,247.51
| Facility | | $42,240.23 | $126,087.09 | $225,247.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,557.44 / $35,071.10 / $46,104.76
| Professional | | $21,557.44 | $35,071.10 | $46,104.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,549.34 / $60,964.39 / $78,510.61
| Facility | | $51,549.34 | $60,964.39 | $78,510.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,211.93 / $41,889.51 / $41,889.51
| Professional | | $36,211.93 | $41,889.51 | $41,889.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $31,290.51
| Facility | | $31,290.51 | $31,290.51 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $31,290.51 / $56,076.38
| Professional | | $22,842.07 | $31,290.51 | $56,076.38 |
- 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
- $38,224.85 / $38,224.85 / $40,136.08
| Professional | | $38,224.85 | $38,224.85 | $40,136.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34,466.03 / $34,466.03 / $34,466.03
| Professional | | $34,466.03 | $34,466.03 | $34,466.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98,192.64 / $225,247.51 / $225,247.51
| Facility | | $98,192.64 | $225,247.51 | $225,247.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,441.90 / $25,236.21 / $46,104.76
| Professional | | $18,441.90 | $25,236.21 | $46,104.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,504.41 / $25,236.21 / $46,104.76
| Professional | | $20,504.41 | $25,236.21 | $46,104.76 |