- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.55 / $2,718.79 / $3,028.15
| Professional | | $1,835.55 | $2,718.79 | $3,028.15 |
- 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
- $2,716.01 / $3,216.98 / $4,812.09
| Professional | | $2,716.01 | $3,216.98 | $4,812.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,731.87 / $3,337.26 / $5,018.89
| Professional | | $2,731.87 | $3,337.26 | $5,018.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,719.11 / $3,501.98 / $5,372.23
| Professional | | $2,719.11 | $3,501.98 | $5,372.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.55 / $2,718.79 / $3,028.15
| Professional | | $1,835.55 | $2,718.79 | $3,028.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,706.72 / $3,575.88 / $4,652.12
| Professional | | $2,706.72 | $3,575.88 | $4,652.12 |