- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,915.67 / $2,465.53 / $3,304.40
| Professional | | $1,915.67 | $2,465.53 | $3,304.40 |
- 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
- $2,520.03 / $2,951.58 / $4,355.97
| Professional | | $2,520.03 | $2,951.58 | $4,355.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,395.23 / $3,020.90 / $4,542.05
| Professional | | $2,395.23 | $3,020.90 | $4,542.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,461.38 / $3,170.05 / $4,863.03
| Professional | | $2,461.38 | $3,170.05 | $4,863.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,202.94 / $2,465.53 / $3,012.45
| Professional | | $2,202.94 | $2,465.53 | $3,012.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,316.33 / $3,089.24 / $4,206.30
| Professional | | $2,316.33 | $3,089.24 | $4,206.30 |