- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67,535.48 / $67,535.48 / $76,157.30
| Facility | | $67,535.48 | $67,535.48 | $76,157.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65,908.12 / $67,535.48 / $69,162.84
| Professional | | $65,908.12 | $67,535.48 | $69,162.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,824.55 / $71,197.05 / $216,303.40
| Facility | | $56,824.55 | $71,197.05 | $216,303.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $67,806.71
| Professional | | $67,806.71 | $67,806.71 | $67,806.71 |
- 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
- $81,368.05 / $81,368.05 / $81,368.05
| Professional | | $81,368.05 | $81,368.05 | $81,368.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,328.75 / $16,328.75 / $16,328.75
| Facility | | $16,328.75 | $16,328.75 | $16,328.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67,806.71 / $67,806.71 / $67,806.71
| Professional | | $67,806.71 | $67,806.71 | $67,806.71 |