- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,472.79 / $2,472.79 / $3,050.13
| Professional | | $2,472.79 | $2,472.79 | $3,050.13 |
- 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
- $2,575.15 / $2,955.41 / $4,357.95
| Professional | | $2,575.15 | $2,955.41 | $4,357.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,495.46 / $3,024.32 / $4,547.04
| Professional | | $2,495.46 | $3,024.32 | $4,547.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,462.50 / $3,171.49 / $4,865.22
| Professional | | $2,462.50 | $3,171.49 | $4,865.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,472.79 / $2,472.79 / $3,050.13
| Professional | | $2,472.79 | $2,472.79 | $3,050.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,494.50 / $3,022.48 / $4,586.52
| Professional | | $2,494.50 | $3,022.48 | $4,586.52 |