- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,139.15 / $2,729.98 / $3,655.03
| Professional | | $2,139.15 | $2,729.98 | $3,655.03 |
- 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
- $2,896.89 / $3,266.24 / $4,819.96
| Professional | | $2,896.89 | $3,266.24 | $4,819.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,740.22 / $3,342.77 / $5,026.53
| Professional | | $2,740.22 | $3,342.77 | $5,026.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,723.56 / $3,507.71 / $5,381.02
| Professional | | $2,723.56 | $3,507.71 | $5,381.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,436.69 / $2,729.98 / $3,362.51
| Professional | | $2,436.69 | $2,729.98 | $3,362.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,286.61 / $3,421.07 / $4,653.67
| Professional | | $2,286.61 | $3,421.07 | $4,653.67 |