- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,094.44 / $80,165.60 / $84,173.90
| Facility | | $65,094.44 | $80,165.60 | $84,173.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65,094.44 / $65,094.44 / $67,535.48
| Professional | | $65,094.44 | $65,094.44 | $67,535.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55,593.32 / $91,539.06 / $204,113.78
| Facility | | $55,593.32 | $91,539.06 | $204,113.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,593.32 / $55,593.32 / $74,124.42
| Professional | | $55,593.32 | $55,593.32 | $74,124.42 |
- 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
- $64,132.46 / $76,603.47 / $284,122.75
| Facility | | $64,132.46 | $76,603.47 | $284,122.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57,635.70 / $67,806.71 / $82,927.61
| Professional | | $57,635.70 | $67,806.71 | $82,927.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66,450.58 / $67,806.71 / $78,452.36
| Professional | | $66,450.58 | $67,806.71 | $78,452.36 |