- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.02 / $1,863.02 / $1,969.52
| Professional | | $1,863.02 | $1,863.02 | $1,969.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,671.44 / $51,449.63 / $58,015.97
| Facility | | $39,671.44 | $51,449.63 | $58,015.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.39 / $1,658.11 / $2,293.00
| Professional | | $1,409.39 | $1,658.11 | $2,293.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,722.27 / $1,917.14 / $2,983.07
| Professional | | $1,722.27 | $1,917.14 | $2,983.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.02 / $1,863.02 / $1,969.52
| Professional | | $1,863.02 | $1,863.02 | $1,969.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.13 / $2,574.63 / $3,107.32
| Professional | | $1,988.13 | $2,574.63 | $3,107.32 |