- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.92 / $3,700.69 / $79,555.60
| Professional | | $1,158.92 | $3,700.69 | $79,555.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,030.73 / $34,409.62 / $65,914.10
| Facility | | $19,030.73 | $34,409.62 | $65,914.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.58 / $1,476.94 / $18,654.24
| Professional | | $982.58 | $1,476.94 | $18,654.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,735.09 / $28,595.75 / $50,143.25
| Facility | | $19,735.09 | $28,595.75 | $50,143.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,402.16 / $20,184.83 / $29,889.95
| Professional | | $13,402.16 | $20,184.83 | $29,889.95 |