- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.80 / $2,127.10 / $2,597.26
| Professional | | $1,716.80 | $2,127.10 | $2,597.26 |
- 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
- $2,146.84 / $2,778.27 / $3,920.70
| Professional | | $2,146.84 | $2,778.27 | $3,920.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.80 / $3,116.71 / $4,400.04
| Professional | | $2,076.80 | $3,116.71 | $4,400.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,559.76 / $2,961.64 / $4,543.32
| Professional | | $2,559.76 | $2,961.64 | $4,543.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.80 / $2,517.10 / $2,597.26
| Professional | | $1,716.80 | $2,517.10 | $2,597.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,006.79 / $2,842.15 / $4,051.52
| Professional | | $2,006.79 | $2,842.15 | $4,051.52 |