- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.66 / $1,583.57 / $1,745.85
| Professional | | $1,170.66 | $1,583.57 | $1,745.85 |
- 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
- $1,462.40 / $1,892.52 / $2,660.43
| Professional | | $1,462.40 | $1,892.52 | $2,660.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.20 / $2,095.01 / $3,034.41
| Professional | | $1,403.20 | $2,095.01 | $3,034.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.35 / $1,999.70 / $3,067.65
| Professional | | $1,728.35 | $1,999.70 | $3,067.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.66 / $1,745.85 / $1,902.67
| Professional | | $1,170.66 | $1,745.85 | $1,902.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.85 / $1,923.37 / $2,781.58
| Professional | | $1,326.85 | $1,923.37 | $2,781.58 |