- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,290.31 / $21,290.31 / $22,993.53
| Facility | | $21,290.31 | $21,290.31 | $22,993.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,290.31 / $22,993.53 / $42,580.62
| Professional | | $21,290.31 | $22,993.53 | $42,580.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,954.82 / $28,954.82 / $28,954.82
| Professional | | $28,954.82 | $28,954.82 | $28,954.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,628.26 / $48,628.26 / $48,628.26
| Facility | | $48,628.26 | $48,628.26 | $48,628.26 |
- 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 / $22,842.07 / $31,290.51
| Professional | | $22,842.07 | $22,842.07 | $31,290.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81,262.88 / $225,247.51 / $225,247.51
| Facility | | $81,262.88 | $225,247.51 | $225,247.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243,527.58 / $243,527.58 / $354,084.53
| Professional | | $243,527.58 | $243,527.58 | $354,084.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,917.11 / $36,507.91 / $48,628.26
| Facility | | $13,917.11 | $36,507.91 | $48,628.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,074.18 / $43,765.43 / $48,628.26
| Professional | | $14,074.18 | $43,765.43 | $48,628.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,917.11 / $32,492.07 / $48,628.26
| Facility | | $13,917.11 | $32,492.07 | $48,628.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $22,842.07 / $32,229.23
| Professional | | $22,842.07 | $22,842.07 | $32,229.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,964.53 / $26,575.48 / $32,492.07
| Professional | | $17,964.53 | $26,575.48 | $32,492.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,785.66 / $27,870.24 / $48,628.26
| Professional | | $26,785.66 | $27,870.24 | $48,628.26 |