- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,515.23 / $40,515.23 / $40,515.23
| Facility | | $40,515.23 | $40,515.23 | $40,515.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,330.06 / $38,051.69 / $40,515.23
| Professional | | $22,330.06 | $38,051.69 | $40,515.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,436.03 / $48,370.76 / $67,354.89
| Facility | | $41,436.03 | $48,370.76 | $67,354.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,696.61 / $45,952.22 / $48,370.76
| Professional | | $38,696.61 | $45,952.22 | $48,370.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $149,246.25 / $414,518.82
| Facility | | $31,290.51 | $149,246.25 | $414,518.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56,076.38 / $59,440.96 / $71,217.00
| Professional | | $56,076.38 | $59,440.96 | $71,217.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88,605.72 / $143,194.46 / $326,392.78
| Facility | | $88,605.72 | $143,194.46 | $326,392.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56,076.38 / $56,076.38 / $57,704.80
| Professional | | $56,076.38 | $56,076.38 | $57,704.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,334.62 / $48,370.76 / $225,247.51
| Facility | | $14,334.62 | $48,370.76 | $225,247.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,371.62 / $24,108.40 / $48,572.97
| Professional | | $14,371.62 | $24,108.40 | $48,572.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,371.62 / $23,124.31 / $48,572.97
| Professional | | $14,371.62 | $23,124.31 | $48,572.97 |