- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,649.80 / $2,121.52 / $2,591.60
| Professional | | $1,649.80 | $2,121.52 | $2,591.60 |
- 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
- $2,225.64 / $2,544.92 / $3,755.04
| Professional | | $2,225.64 | $2,544.92 | $3,755.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,992.13 / $2,606.33 / $3,918.67
| Professional | | $1,992.13 | $2,606.33 | $3,918.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.82 / $2,732.73 / $4,192.14
| Professional | | $2,121.82 | $2,732.73 | $4,192.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,649.80 / $2,121.52 / $2,591.60
| Professional | | $1,649.80 | $2,121.52 | $2,591.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,307.86 / $2,840.45 / $3,633.65
| Professional | | $2,307.86 | $2,840.45 | $3,633.65 |