- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.77 / $2,595.52 / $3,186.78
| Professional | | $2,102.77 | $2,595.52 | $3,186.78 |
- 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
- $2,626.55 / $3,399.06 / $4,788.01
| Professional | | $2,626.55 | $3,399.06 | $4,788.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.76 / $3,695.14 / $5,377.24
| Professional | | $2,405.76 | $3,695.14 | $5,377.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,125.71 / $3,616.45 / $5,547.82
| Professional | | $3,125.71 | $3,616.45 | $5,547.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.77 / $2,762.36 / $3,186.78
| Professional | | $2,102.77 | $2,762.36 | $3,186.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.02 / $3,535.71 / $4,941.06
| Professional | | $2,167.02 | $3,535.71 | $4,941.06 |