- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,772.37 / $30,902.95
| Professional | | $7,585.78 | $9,772.37 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $39,810.72 / $46,773.51
| Facility | | $29,512.09 | $39,810.72 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $21,379.62
| Professional | | $7,943.28 | $10,471.29 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $12,589.25
| Facility | | $11,481.54 | $11,481.54 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $12,589.25
| Professional | | $9,120.11 | $9,120.11 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $13,489.63 / $23,988.33
| Facility | | $11,481.54 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,481.54 / $16,595.87
| Professional | | $9,120.11 | $11,481.54 | $16,595.87 |