- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $2,290.87
| Professional | | $1,096.48 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $43,651.58 / $57,543.99
| Facility | | $40,738.03 | $43,651.58 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,659.59 / $3,019.95
| Professional | | $1,445.44 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,570.40
| Professional | | $1,258.93 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $2,089.30
| Professional | | $1,096.48 | $1,862.09 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,398.83 / $2,884.03
| Professional | | $1,348.96 | $2,398.83 | $2,884.03 |