- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,568.04 / $12,037.88 / $12,987.91
| Professional | | $9,568.04 | $12,037.88 | $12,987.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,961.33 / $41,817.36 / $49,506.85
| Facility | | $30,961.33 | $41,817.36 | $49,506.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,782.03 / $11,508.27 / $19,246.73
| Professional | | $9,782.03 | $11,508.27 | $19,246.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $14,513.81
| Facility | | $14,513.81 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $14,513.81 / $14,513.81
| Professional | | $10,595.08 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,874.11 / $14,345.15 / $18,208.18
| Professional | | $9,874.11 | $14,345.15 | $18,208.18 |