- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.17 / $1,093.89 / $1,395.28
| Professional | | $560.17 | $1,093.89 | $1,395.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,569.01 / $56,593.28 / $65,823.96
| Facility | | $44,569.01 | $56,593.28 | $65,823.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.39 / $1,373.03 / $1,442.92
| Professional | | $1,325.39 | $1,373.03 | $1,442.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.29 / $1,606.25 / $2,464.08
| Professional | | $1,388.29 | $1,606.25 | $2,464.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.17 / $1,093.89 / $1,395.28
| Professional | | $560.17 | $1,093.89 | $1,395.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.77 / $856.62 / $1,332.63
| Professional | | $590.77 | $856.62 | $1,332.63 |