- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.80 / $2,167.40 / $2,502.82
| Professional | | $1,768.80 | $2,167.40 | $2,502.82 |
- 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
- $2,227.05 / $2,882.06 / $4,241.95
| Professional | | $2,227.05 | $2,882.06 | $4,241.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.62 / $3,236.40 / $4,613.54
| Professional | | $2,335.62 | $3,236.40 | $4,613.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,668.17 / $3,087.07 / $4,735.72
| Professional | | $2,668.17 | $3,087.07 | $4,735.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.80 / $2,502.82 / $3,024.79
| Professional | | $1,768.80 | $2,502.82 | $3,024.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.71 / $2,935.87 / $4,275.60
| Professional | | $2,049.71 | $2,935.87 | $4,275.60 |