- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.97 / $2,203.67 / $2,697.44
| Professional | | $1,746.97 | $2,203.67 | $2,697.44 |
- 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
- $2,208.25 / $2,857.74 / $4,021.06
| Professional | | $2,208.25 | $2,857.74 | $4,021.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.96 / $3,197.56 / $4,546.84
| Professional | | $2,131.96 | $3,197.56 | $4,546.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,626.13 / $3,038.43 / $4,661.12
| Professional | | $2,626.13 | $3,038.43 | $4,661.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.97 / $2,328.17 / $2,697.44
| Professional | | $1,746.97 | $2,328.17 | $2,697.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.99 / $2,740.49 / $4,170.18
| Professional | | $1,889.99 | $2,740.49 | $4,170.18 |