- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,903.24 / $1,903.24 / $1,982.94
| Professional | | $1,903.24 | $1,903.24 | $1,982.94 |
- 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
- $2,439.17 / $2,715.16 / $4,224.79
| Professional | | $2,439.17 | $2,715.16 | $4,224.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,903.24 / $1,903.24 / $1,982.94
| Professional | | $1,903.24 | $1,903.24 | $1,982.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.29 / $2,584.84 / $3,342.47
| Professional | | $1,946.29 | $2,584.84 | $3,342.47 |