- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,046.41 / $22,046.41 / $25,438.17
| Professional | | $22,046.41 | $22,046.41 | $25,438.17 |
- 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 / $24,418.89 / $32,398.44
| Professional | | $22,185.52 | $24,418.89 | $32,398.44 |
- 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 / $30,391.12 / $32,398.44
| Professional | | $22,185.52 | $30,391.12 | $32,398.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,025.85 / $29,471.91 / $52,227.95
| Professional | | $15,025.85 | $29,471.91 | $52,227.95 |