- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,362.07 / $2,937.09 / $3,554.44
| Professional | | $2,362.07 | $2,937.09 | $3,554.44 |
- 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
- $2,929.04 / $3,790.53 / $5,340.57
| Professional | | $2,929.04 | $3,790.53 | $5,340.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,797.11 / $4,248.24 / $6,063.16
| Professional | | $2,797.11 | $4,248.24 | $6,063.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,465.37 / $4,009.43 / $6,150.69
| Professional | | $3,465.37 | $4,009.43 | $6,150.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,362.07 / $3,174.52 / $3,554.44
| Professional | | $2,362.07 | $3,174.52 | $3,554.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,701.37 / $4,154.84 / $5,770.61
| Professional | | $2,701.37 | $4,154.84 | $5,770.61 |