- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.13 / $2,481.98 / $3,054.30
| Professional | | $1,943.13 | $2,481.98 | $3,054.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,990.11 / $32,409.51 / $36,545.83
| Facility | | $24,990.11 | $32,409.51 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.25 / $2,970.79 / $4,382.85
| Professional | | $2,570.25 | $2,970.79 | $4,382.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.78 / $3,040.57 / $4,572.52
| Professional | | $2,405.78 | $3,040.57 | $4,572.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,476.57 / $3,189.61 / $4,893.03
| Professional | | $2,476.57 | $3,189.61 | $4,893.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,796.99 / $2,481.98 / $3,054.30
| Professional | | $1,796.99 | $2,481.98 | $3,054.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.06 / $3,169.56 / $4,233.49
| Professional | | $2,128.06 | $3,169.56 | $4,233.49 |