- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,739.45 / $30,427.35 / $30,427.35
| Professional | | $19,739.45 | $30,427.35 | $30,427.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,181.26 / $52,058.55 / $96,500.10
| Facility | | $40,181.26 | $52,058.55 | $96,500.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,953.47 / $25,020.52 / $33,917.56
| Professional | | $23,953.47 | $25,020.52 | $33,917.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $33,205.32
| Facility | | $30,391.12 | $30,391.12 | $33,205.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $22,185.52 / $30,391.12
| Professional | | $22,185.52 | $22,185.52 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,578.56 / $36,578.56 / $36,578.56
| Professional | | $36,578.56 | $36,578.56 | $36,578.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,438.17 / $30,427.35 / $30,427.35
| Professional | | $25,438.17 | $30,427.35 | $30,427.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,025.85 / $29,471.91 / $51,832.21
| Professional | | $15,025.85 | $29,471.91 | $51,832.21 |