- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,181.52 / $2,199.28 / $2,498.57
| Professional | | $2,181.52 | $2,199.28 | $2,498.57 |
- 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
- $2,382.26 / $2,802.67 / $3,611.50
| Professional | | $2,382.26 | $2,802.67 | $3,611.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,866.44 / $3,316.47 / $5,087.64
| Professional | | $2,866.44 | $3,316.47 | $5,087.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,181.52 / $2,199.28 / $2,494.15
| Professional | | $2,181.52 | $2,199.28 | $2,494.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,185.80 / $3,178.47 / $4,584.47
| Professional | | $2,185.80 | $3,178.47 | $4,584.47 |