- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.81 / $1,683.03 / $2,193.82
| Professional | | $1,421.81 | $1,683.03 | $2,193.82 |
- 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
- $1,774.80 / $2,296.80 / $3,225.81
| Professional | | $1,774.80 | $2,296.80 | $3,225.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,710.49 / $2,611.09 / $3,712.56
| Professional | | $1,710.49 | $2,611.09 | $3,712.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,106.75 / $2,437.51 / $3,739.27
| Professional | | $2,106.75 | $2,437.51 | $3,739.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.81 / $1,683.03 / $2,193.82
| Professional | | $1,421.81 | $1,683.03 | $2,193.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.40 / $2,378.11 / $3,398.23
| Professional | | $1,606.40 | $2,378.11 | $3,398.23 |