- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,038.65 / $23,038.65 / $26,583.06
| Professional | | $23,038.65 | $23,038.65 | $26,583.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $31,290.51
| Facility | | $31,290.51 | $31,290.51 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $22,842.07 / $32,229.23
| Professional | | $22,842.07 | $22,842.07 | $32,229.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,290.51 / $31,290.51 / $31,290.51
| Facility | | $31,290.51 | $31,290.51 | $31,290.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,842.07 / $31,290.51 / $32,229.23
| Professional | | $22,842.07 | $31,290.51 | $32,229.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,702.12 / $32,480.45 / $39,255.31
| Professional | | $15,702.12 | $32,480.45 | $39,255.31 |