- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,358.73 / $2,668.41 / $2,928.93
| Professional | | $2,358.73 | $2,668.41 | $2,928.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,491.08 / $26,838.03 / $30,263.27
| Facility | | $20,491.08 | $26,838.03 | $30,263.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,427.50 / $3,022.65 / $4,555.18
| Professional | | $2,427.50 | $3,022.65 | $4,555.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.00 / $699.00 / $2,543.44
| Facility | | $699.00 | $699.00 | $2,543.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.17 / $3,217.00 / $4,801.58
| Professional | | $2,007.17 | $3,217.00 | $4,801.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,471.01 / $3,182.46 / $4,980.00
| Professional | | $2,471.01 | $3,182.46 | $4,980.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,358.73 / $2,668.41 / $5,140.20
| Professional | | $2,358.73 | $2,668.41 | $5,140.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,242.36 / $3,314.15 / $4,301.56
| Professional | | $2,242.36 | $3,314.15 | $4,301.56 |