- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.30 / $2,135.21 / $2,464.46
| Professional | | $1,634.30 | $2,135.21 | $2,464.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,491.08 / $26,019.37 / $30,263.27
| Facility | | $20,491.08 | $26,019.37 | $30,263.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.82 / $2,630.71 / $3,709.58
| Professional | | $2,032.82 | $2,630.71 | $3,709.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,947.78 / $2,953.92 / $4,212.83
| Professional | | $1,947.78 | $2,953.92 | $4,212.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.60 / $2,783.28 / $4,269.70
| Professional | | $2,405.60 | $2,783.28 | $4,269.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.30 / $2,464.46 / $2,503.04
| Professional | | $1,634.30 | $2,464.46 | $2,503.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,903.61 / $2,926.85 / $3,784.73
| Professional | | $1,903.61 | $2,926.85 | $3,784.73 |