- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,277.42 / $2,277.42 / $2,801.78
| Professional | | $2,277.42 | $2,277.42 | $2,801.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,990.11 / $32,409.51 / $36,545.83
| Facility | | $24,990.11 | $32,409.51 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,395.09 / $2,724.27 / $4,021.11
| Professional | | $2,395.09 | $2,724.27 | $4,021.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.41 / $2,789.38 / $4,195.49
| Professional | | $2,168.41 | $2,789.38 | $4,195.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,272.16 / $2,926.35 / $4,489.18
| Professional | | $2,272.16 | $2,926.35 | $4,489.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,277.42 / $2,277.42 / $2,801.78
| Professional | | $2,277.42 | $2,277.42 | $2,801.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.12 / $2,918.19 / $3,886.44
| Professional | | $2,195.12 | $2,918.19 | $3,886.44 |