- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,427.62 / $3,056.85 / $3,442.66
| Professional | | $2,427.62 | $3,056.85 | $3,442.66 |
- 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
- $3,086.01 / $3,993.66 / $6,051.97
| Professional | | $3,086.01 | $3,993.66 | $6,051.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,195.10 / $4,471.06 / $6,311.27
| Professional | | $3,195.10 | $4,471.06 | $6,311.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,806.67 / $4,404.32 / $6,756.46
| Professional | | $3,806.67 | $4,404.32 | $6,756.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,427.62 / $3,442.66 / $4,232.00
| Professional | | $2,427.62 | $3,442.66 | $4,232.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,819.42 / $4,045.36 / $5,834.77
| Professional | | $2,819.42 | $4,045.36 | $5,834.77 |