- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.97 / $1,809.59 / $2,209.57
| Professional | | $1,597.97 | $1,809.59 | $2,209.57 |
- 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
- $1,811.15 / $2,343.84 / $3,302.81
| Professional | | $1,811.15 | $2,343.84 | $3,302.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,753.10 / $2,635.67 / $3,730.87
| Professional | | $1,753.10 | $2,635.67 | $3,730.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,157.04 / $2,495.69 / $3,828.53
| Professional | | $2,157.04 | $2,495.69 | $3,828.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.97 / $2,209.57 / $3,212.23
| Professional | | $1,597.97 | $2,209.57 | $3,212.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,480.70 / $2,315.55 / $3,425.22
| Professional | | $1,480.70 | $2,315.55 | $3,425.22 |