- 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
- $66,721.80 / $69,162.84 / $69,162.84
| Professional | | $66,721.80 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,014.04 / $64,335.02 / $86,551.19
| Facility | | $53,014.04 | $64,335.02 | $86,551.19 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $64,619.79 / $67,806.71 / $67,806.71
| Professional | | $64,619.79 | $67,806.71 | $67,806.71 |