- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,176.53 / $2,784.52 / $3,276.98
| Professional | | $2,176.53 | $2,784.52 | $3,276.98 |
- 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
- $2,701.02 / $3,495.44 / $4,925.35
| Professional | | $2,701.02 | $3,495.44 | $4,925.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,581.42 / $3,919.25 / $5,592.31
| Professional | | $2,581.42 | $3,919.25 | $5,592.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,196.20 / $3,698.00 / $5,672.94
| Professional | | $3,196.20 | $3,698.00 | $5,672.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,176.53 / $3,276.98 / $3,288.30
| Professional | | $2,176.53 | $3,276.98 | $3,288.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,451.59 / $3,547.73 / $5,135.93
| Professional | | $2,451.59 | $3,547.73 | $5,135.93 |