- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,798.34 / $19,798.34 / $19,798.34
| Facility | | $19,798.34 | $19,798.34 | $19,798.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,550.64 / $18,369.00 / $19,798.34
| Professional | | $10,550.64 | $18,369.00 | $19,798.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $25,229.38 / $33,234.51
| Facility | | $1.00 | $25,229.38 | $33,234.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,909.66 / $22,843.37 / $23,637.07
| Professional | | $18,909.66 | $22,843.37 | $23,637.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.23 / $72,931.64 / $202,561.44
| Facility | | $13,034.23 | $72,931.64 | $202,561.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,402.38 / $29,046.52 / $34,801.01
| Professional | | $27,402.38 | $29,046.52 | $34,801.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,298.64 / $69,974.33 / $159,497.20
| Facility | | $43,298.64 | $69,974.33 | $159,497.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,402.38 / $27,402.38 / $28,198.40
| Professional | | $27,402.38 | $27,402.38 | $28,198.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,919.85 / $23,637.07 / $100,282.95
| Facility | | $6,919.85 | $23,637.07 | $100,282.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,937.71 / $11,625.28 / $23,735.88
| Professional | | $6,937.71 | $11,625.28 | $23,735.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,937.71 / $11,620.67 / $41,518.51
| Professional | | $6,937.71 | $11,620.67 | $41,518.51 |