- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.41 / $2,151.07 / $2,634.21
| Professional | | $1,738.41 | $2,151.07 | $2,634.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,744.96 / $31,420.90 / $36,545.83
| Facility | | $24,744.96 | $31,420.90 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,173.31 / $2,812.52 / $3,966.78
| Professional | | $2,173.31 | $2,812.52 | $3,966.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.31 / $3,148.22 / $4,452.33
| Professional | | $2,100.31 | $3,148.22 | $4,452.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,590.67 / $2,997.42 / $4,598.20
| Professional | | $2,590.67 | $2,997.42 | $4,598.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.41 / $2,425.29 / $2,634.21
| Professional | | $1,738.41 | $2,425.29 | $2,634.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,019.51 / $2,928.29 / $4,096.77
| Professional | | $2,019.51 | $2,928.29 | $4,096.77 |