- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $20,892.96 / $93,325.43
| Professional | | $17,378.01 | $20,892.96 | $93,325.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Facility | | $31,622.78 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $22,908.68
| Professional | | $22,908.68 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $28,183.83 / $32,359.37
| Facility | | $34.67 | $28,183.83 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,379.62 / $25,118.86 / $35,481.34
| Professional | | $21,379.62 | $25,118.86 | $35,481.34 |