- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,194.11 / $10,216.62 / $11,122.91
| Professional | | $8,194.11 | $10,216.62 | $11,122.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,515.43 / $35,812.57 / $42,397.88
| Facility | | $26,515.43 | $35,812.57 | $42,397.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,377.37 / $9,855.74 / $16,482.98
| Professional | | $8,377.37 | $9,855.74 | $16,482.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,847.64 / $11,736.82 / $11,736.82
| Facility | | $10,847.64 | $11,736.82 | $11,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $11,736.82 / $11,736.82
| Professional | | $8,567.87 | $11,736.82 | $11,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,486.39 / $10,710.19 / $15,593.58
| Professional | | $8,486.39 | $10,710.19 | $15,593.58 |