- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,067.17 / $2,575.61 / $3,160.93
| Professional | | $2,067.17 | $2,575.61 | $3,160.93 |
- 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
- $2,583.83 / $3,343.78 / $4,700.18
| Professional | | $2,583.83 | $3,343.78 | $4,700.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,489.81 / $3,746.52 / $5,317.76
| Professional | | $2,489.81 | $3,746.52 | $5,317.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,069.65 / $3,551.58 / $5,448.32
| Professional | | $3,069.65 | $3,551.58 | $5,448.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,067.17 / $2,881.66 / $3,160.93
| Professional | | $2,067.17 | $2,881.66 | $3,160.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,169.59 / $3,287.38 / $4,874.64
| Professional | | $2,169.59 | $3,287.38 | $4,874.64 |