- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,050.59 / $3,217.48 / $3,393.47
| Professional | | $2,050.59 | $3,217.48 | $3,393.47 |
- 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
- $3,344.79 / $3,797.98 / $5,591.27
| Professional | | $3,344.79 | $3,797.98 | $5,591.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,747.15 / $3,912.70 / $5,984.85
| Professional | | $2,747.15 | $3,912.70 | $5,984.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,159.40 / $4,069.04 / $6,242.13
| Professional | | $3,159.40 | $4,069.04 | $6,242.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,050.59 / $3,217.48 / $3,393.47
| Professional | | $2,050.59 | $3,217.48 | $3,393.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,559.29 / $3,552.86 / $5,480.62
| Professional | | $2,559.29 | $3,552.86 | $5,480.62 |