- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.80 / $2,248.80 / $2,764.67
| Professional | | $2,248.80 | $2,248.80 | $2,764.67 |
- 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
- $2,348.94 / $2,693.39 / $3,973.27
| Professional | | $2,348.94 | $2,693.39 | $3,973.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,155.25 / $2,757.22 / $4,146.76
| Professional | | $2,155.25 | $2,757.22 | $4,146.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,245.13 / $2,891.54 / $4,435.78
| Professional | | $2,245.13 | $2,891.54 | $4,435.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,248.80 / $2,248.80 / $2,764.67
| Professional | | $2,248.80 | $2,248.80 | $2,764.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,877.93 / $2,640.77 / $3,840.44
| Professional | | $1,877.93 | $2,640.77 | $3,840.44 |