- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,739.45 / $23,548.73 / $26,794.87
| Professional | | $19,739.45 | $23,548.73 | $26,794.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,875.15 / $86,271.80 / $102,135.69
| Facility | | $63,875.15 | $86,271.80 | $102,135.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,180.95 / $23,742.29 / $39,707.18
| Professional | | $20,180.95 | $23,742.29 | $39,707.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,131.79 / $30,391.12 / $30,391.12
| Facility | | $26,131.79 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $30,391.12
| Professional | | $22,185.52 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,370.91 / $25,402.98 / $37,564.62
| Professional | | $20,370.91 | $25,402.98 | $37,564.62 |