- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $16,982.44 / $19,498.45
| Professional | | $12,302.69 | $16,982.44 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $16,595.87
| Professional | | $12,022.64 | $12,022.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,877.62 / $27,542.29 / $34,673.69
| Professional | | $21,877.62 | $27,542.29 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $20,417.38
| Facility | | $371.54 | $489.78 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $20,892.96 / $33,113.11
| Professional | | $9,772.37 | $20,892.96 | $33,113.11 |