- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $21,877.62 / $28,840.32
| Professional | | $19,054.61 | $21,877.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,904.51 / $46,773.51 / $53,703.18
| Facility | | $38,904.51 | $46,773.51 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $53,703.18 / $53,703.18
| Professional | | $40,738.03 | $53,703.18 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $30,902.95
| Professional | | $30,902.95 | $30,902.95 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34,673.69 / $34,673.69 / $41,686.94
| Professional | | $34,673.69 | $34,673.69 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $26,915.35 / $46,773.51
| Professional | | $19,952.62 | $26,915.35 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $19,952.62 / $19,952.62
| Facility | | $13,182.57 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,791.08 / $23,442.29 / $40,738.03
| Professional | | $14,791.08 | $23,442.29 | $40,738.03 |