- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,120.11 / $28,840.32
| Professional | | $7,413.10 | $9,120.11 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $37,153.52 / $43,651.58
| Facility | | $27,542.29 | $37,153.52 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,772.37 / $19,952.62
| Professional | | $7,413.10 | $9,772.37 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $11,748.98
| Facility | | $10,964.78 | $10,964.78 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $11,748.98
| Professional | | $8,511.38 | $8,511.38 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $13,182.57 / $22,908.68
| Facility | | $11,220.18 | $13,182.57 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $10,715.19 / $15,488.17
| Professional | | $8,511.38 | $10,715.19 | $15,488.17 |