- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $9,772.37 / $43,651.58
| Professional | | $8,128.31 | $9,772.37 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Professional | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $13,182.57 / $15,135.61
| Facility | | $15.85 | $13,182.57 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,748.98 / $16,595.87
| Professional | | $9,772.37 | $11,748.98 | $16,595.87 |