- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,482.35 / $19,107.96 / $29,571.30
| Professional | | $15,482.35 | $19,107.96 | $29,571.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,479.75 / $26,479.75 / $26,479.75
| Professional | | $26,479.75 | $26,479.75 | $26,479.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $31,019.05
| Professional | | $31,019.05 | $31,019.05 | $31,019.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,479.75 / $37,828.21 / $54,472.62
| Professional | | $26,479.75 | $37,828.21 | $54,472.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,218.03 / $20,283.02 / $32,461.22
| Professional | | $18,218.03 | $20,283.02 | $32,461.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,479.75 / $34,733.21 / $34,733.21
| Professional | | $26,479.75 | $34,733.21 | $34,733.21 |