- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,411.61 / $2,411.61 / $2,502.15
| Professional | | $2,411.61 | $2,411.61 | $2,502.15 |
- 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
- $2,529.42 / $2,782.50 / $4,140.37
| Professional | | $2,529.42 | $2,782.50 | $4,140.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,079.71 / $2,919.69 / $4,432.68
| Professional | | $2,079.71 | $2,919.69 | $4,432.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,339.56 / $3,013.15 / $4,622.34
| Professional | | $2,339.56 | $3,013.15 | $4,622.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,838.57 / $2,411.61 / $2,502.15
| Professional | | $1,838.57 | $2,411.61 | $2,502.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,989.46 / $2,604.28 / $4,076.04
| Professional | | $1,989.46 | $2,604.28 | $4,076.04 |