- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,814.18 / $2,265.59 / $2,734.25
| Professional | | $1,814.18 | $2,265.59 | $2,734.25 |
- 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
- $2,254.14 / $2,917.13 / $4,113.99
| Professional | | $2,254.14 | $2,917.13 | $4,113.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,157.90 / $3,274.08 / $4,669.91
| Professional | | $2,157.90 | $3,274.08 | $4,669.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,667.76 / $3,086.60 / $4,735.01
| Professional | | $2,667.76 | $3,086.60 | $4,735.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,814.18 / $2,568.34 / $2,734.25
| Professional | | $1,814.18 | $2,568.34 | $2,734.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,859.29 / $2,970.06 / $4,293.08
| Professional | | $1,859.29 | $2,970.06 | $4,293.08 |