- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.74 / $1,473.47 / $1,786.30
| Professional | | $1,158.74 | $1,473.47 | $1,786.30 |
- 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
- $1,469.11 / $1,901.20 / $2,689.34
| Professional | | $1,469.11 | $1,901.20 | $2,689.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.25 / $2,106.56 / $3,030.71
| Professional | | $1,432.25 | $2,106.56 | $3,030.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.38 / $2,032.13 / $3,117.40
| Professional | | $1,756.38 | $2,032.13 | $3,117.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.74 / $1,532.13 / $1,786.30
| Professional | | $1,158.74 | $1,532.13 | $1,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.91 / $1,781.92 / $2,794.49
| Professional | | $1,228.91 | $1,781.92 | $2,794.49 |