- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,428.40 / $3,057.21 / $3,443.50
| Professional | | $2,428.40 | $3,057.21 | $3,443.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,744.96 / $31,420.90 / $36,545.83
| Facility | | $24,744.96 | $31,420.90 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,104.06 / $4,017.02 / $6,052.63
| Professional | | $3,104.06 | $4,017.02 | $6,052.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,195.86 / $4,471.58 / $6,312.77
| Professional | | $3,195.86 | $4,471.58 | $6,312.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,807.08 / $4,404.79 / $6,757.19
| Professional | | $3,807.08 | $4,404.79 | $6,757.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,428.40 / $3,443.50 / $4,235.60
| Professional | | $2,428.40 | $3,443.50 | $4,235.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,820.10 / $4,049.50 / $5,835.44
| Professional | | $2,820.10 | $4,049.50 | $5,835.44 |