- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $51,660.50
| Professional | | $28,424.06 | $28,424.06 | $51,660.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,178.18 / $32,178.18 / $32,178.18
| Facility | | $32,178.18 | $32,178.18 | $32,178.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,815.15 / $30,645.89 / $51,076.48
| Facility | | $26,815.15 | $30,645.89 | $51,076.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $51,076.48
| Professional | | $28,424.06 | $28,424.06 | $51,076.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,815.15 / $30,645.89 / $51,076.48
| Facility | | $26,815.15 | $30,645.89 | $51,076.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $51,076.48
| Professional | | $28,424.06 | $28,424.06 | $51,076.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,351.45 / $30,129.50 / $65,781.80
| Professional | | $27,351.45 | $30,129.50 | $65,781.80 |