- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,667.22 / $2,123.94 / $2,583.58
| Professional | | $1,667.22 | $2,123.94 | $2,583.58 |
- 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
- $2,106.23 / $2,725.73 / $3,824.04
| Professional | | $2,106.23 | $2,725.73 | $3,824.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,042.78 / $2,970.31 / $4,354.71
| Professional | | $2,042.78 | $2,970.31 | $4,354.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,496.28 / $2,888.20 / $4,430.64
| Professional | | $2,496.28 | $2,888.20 | $4,430.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,667.22 / $2,133.67 / $2,583.58
| Professional | | $1,667.22 | $2,133.67 | $2,583.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.83 / $2,454.71 / $3,989.97
| Professional | | $1,756.83 | $2,454.71 | $3,989.97 |