- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.69 / $1,678.22 / $2,081.91
| Professional | | $1,483.69 | $1,678.22 | $2,081.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,491.08 / $26,019.37 / $30,263.27
| Facility | | $20,491.08 | $26,019.37 | $30,263.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,685.84 / $2,181.67 / $3,068.03
| Professional | | $1,685.84 | $2,181.67 | $3,068.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.06 / $2,483.91 / $3,527.53
| Professional | | $1,628.06 | $2,483.91 | $3,527.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,003.70 / $2,318.28 / $3,556.37
| Professional | | $2,003.70 | $2,318.28 | $3,556.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.57 / $1,577.79 / $2,081.91
| Professional | | $1,449.57 | $1,577.79 | $2,081.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.71 / $2,176.07 / $3,231.58
| Professional | | $1,509.71 | $2,176.07 | $3,231.58 |