- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,926.67 / $2,841.76 / $3,465.17
| Professional | | $1,926.67 | $2,841.76 | $3,465.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,744.96 / $31,420.90 / $36,545.83
| Facility | | $24,744.96 | $31,420.90 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,867.63 / $3,711.05 / $5,232.85
| Professional | | $2,867.63 | $3,711.05 | $5,232.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,772.94 / $4,133.43 / $5,877.81
| Professional | | $2,772.94 | $4,133.43 | $5,877.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,417.55 / $3,954.11 / $6,065.81
| Professional | | $3,417.55 | $3,954.11 | $6,065.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,292.48 / $2,971.47 / $4,233.30
| Professional | | $2,292.48 | $2,971.47 | $4,233.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,356.31 / $3,475.37 / $5,317.71
| Professional | | $2,356.31 | $3,475.37 | $5,317.71 |