- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $60,255.96 / $144,543.98
| Facility | | $54,954.09 | $60,255.96 | $144,543.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $64,565.42
| Professional | | $54,954.09 | $54,954.09 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57,543.99 / $74,131.02 / $151,356.12
| Facility | | $57,543.99 | $74,131.02 | $151,356.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $75,857.76
| Professional | | $54,954.09 | $54,954.09 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $54,954.09 / $85,113.80
| Facility | | $51,286.14 | $54,954.09 | $85,113.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $66,069.34
| Professional | | $54,954.09 | $54,954.09 | $66,069.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $54,954.09 / $93,325.43
| Facility | | $54,954.09 | $54,954.09 | $93,325.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $57,543.99 / $63,095.73
| Professional | | $54,954.09 | $57,543.99 | $63,095.73 |