- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.80 / $2,258.37 / $2,730.35
| Professional | | $1,928.80 | $2,258.37 | $2,730.35 |
- 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
- $2,464.09 / $3,188.82 / $4,816.68
| Professional | | $2,464.09 | $3,188.82 | $4,816.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,543.67 / $3,562.75 / $5,024.50
| Professional | | $2,543.67 | $3,562.75 | $5,024.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,029.67 / $3,505.33 / $5,377.36
| Professional | | $3,029.67 | $3,505.33 | $5,377.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.80 / $2,730.35 / $3,336.03
| Professional | | $1,928.80 | $2,730.35 | $3,336.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.58 / $3,212.33 / $4,648.57
| Professional | | $2,215.58 | $3,212.33 | $4,648.57 |