- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,454.32 / $31,800.28 / $40,834.39
| Professional | | $26,454.32 | $31,800.28 | $40,834.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,120.98 / $52,120.98 / $52,120.98
| Facility | | $52,120.98 | $52,120.98 | $52,120.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,437.90 / $38,437.90 / $38,437.90
| Professional | | $38,437.90 | $38,437.90 | $38,437.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,532.48 / $46,759.11 / $50,767.03
| Professional | | $44,532.48 | $46,759.11 | $50,767.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Professional | | $50.00 | $50.00 | $50.00 |