- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67,535.48 / $67,535.48 / $67,535.48
| Facility | | $67,535.48 | $67,535.48 | $67,535.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65,094.44 / $67,535.48 / $67,535.48
| Professional | | $65,094.44 | $67,535.48 | $67,535.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,824.55 / $92,510.37 / $208,546.10
| Facility | | $56,824.55 | $92,510.37 | $208,546.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $70,047.59 / $73,939.13
| Professional | | $67,806.71 | $70,047.59 | $73,939.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69,162.84 / $71,197.03 / $138,838.29
| Facility | | $69,162.84 | $71,197.03 | $138,838.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,824.55 / $69,162.84 / $69,162.84
| Facility | | $56,824.55 | $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
- $55,849.41 / $66,156.06 / $132,312.12
| Professional | | $55,849.41 | $66,156.06 | $132,312.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $74,809.78
| Professional | | $67,806.71 | $67,806.71 | $74,809.78 |