- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,624.02 / $27,624.02 / $27,624.02
| Facility | | $27,624.02 | $27,624.02 | $27,624.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,020.02 / $27,624.02 / $27,624.02
| Professional | | $23,020.02 | $27,624.02 | $27,624.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73,212.17 / $145,866.85 / $265,671.56
| Facility | | $73,212.17 | $145,866.85 | $265,671.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,952.22 / $48,370.76 / $65,300.53
| Professional | | $45,952.22 | $48,370.76 | $65,300.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,687.33 / $31,440.99 / $31,611.31
| Facility | | $30,687.33 | $31,440.99 | $31,611.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,696.61 / $38,696.61 / $38,696.61
| Professional | | $38,696.61 | $38,696.61 | $38,696.61 |
- 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
- $24,457.73 / $31,290.51 / $56,076.38
| Professional | | $24,457.73 | $31,290.51 | $56,076.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,624.02 / $34,954.94 / $34,954.94
| Facility | | $27,624.02 | $34,954.94 | $34,954.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,624.02 / $34,954.94 / $54,404.78
| Professional | | $27,624.02 | $34,954.94 | $54,404.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,425.20 / $35,794.36 / $41,163.51
| Professional | | $30,425.20 | $35,794.36 | $41,163.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,964.53 / $23,124.31 / $34,189.94
| Professional | | $17,964.53 | $23,124.31 | $34,189.94 |