- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67,535.48 / $69,162.84 / $73,625.25
| Facility | | $67,535.48 | $69,162.84 | $73,625.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65,094.44 / $67,535.48 / $69,162.84
| Professional | | $65,094.44 | $67,535.48 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,824.55 / $100,749.93 / $201,352.11
| Facility | | $56,824.55 | $100,749.93 | $201,352.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56,745.87 / $67,806.71 / $70,047.59
| Professional | | $56,745.87 | $67,806.71 | $70,047.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $69,162.84
| Facility | | $69,162.84 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $69,162.84
| Professional | | $69,162.84 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58,910.18 / $58,910.18 / $58,910.18
| Facility | | $58,910.18 | $58,910.18 | $58,910.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $71,942.92
| Professional | | $67,806.71 | $67,806.71 | $71,942.92 |