- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.54 / $2,098.39 / $2,357.17
| Professional | | $1,666.54 | $2,098.39 | $2,357.17 |
- 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
- $2,097.25 / $2,714.09 / $4,165.93
| Professional | | $2,097.25 | $2,714.09 | $4,165.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,200.63 / $3,085.11 / $4,346.89
| Professional | | $2,200.63 | $3,085.11 | $4,346.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,620.36 / $3,031.76 / $4,650.88
| Professional | | $2,620.36 | $3,031.76 | $4,650.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.54 / $2,357.17 / $2,889.96
| Professional | | $1,666.54 | $2,357.17 | $2,889.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,968.40 / $2,870.03 / $4,077.28
| Professional | | $1,968.40 | $2,870.03 | $4,077.28 |