- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.03 / $1,160.38 / $1,366.24
| Professional | | $920.03 | $1,160.38 | $1,366.24 |
- 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
- $1,142.25 / $1,478.21 / $2,081.53
| Professional | | $1,142.25 | $1,478.21 | $2,081.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.40 / $1,639.49 / $2,367.46
| Professional | | $1,101.40 | $1,639.49 | $2,367.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.44 / $1,572.87 / $2,412.87
| Professional | | $1,359.44 | $1,572.87 | $2,412.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.86 / $1,160.38 / $1,366.24
| Professional | | $997.86 | $1,160.38 | $1,366.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,038.33 / $1,630.61 / $2,183.85
| Professional | | $1,038.33 | $1,630.61 | $2,183.85 |