- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,697.62 / $2,126.05 / $2,592.15
| Professional | | $1,697.62 | $2,126.05 | $2,592.15 |
- 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
- $2,124.60 / $2,749.49 / $3,883.46
| Professional | | $2,124.60 | $2,749.49 | $3,883.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,063.85 / $3,101.40 / $4,379.39
| Professional | | $2,063.85 | $3,101.40 | $4,379.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,536.27 / $2,934.46 / $4,501.63
| Professional | | $2,536.27 | $2,934.46 | $4,501.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,697.62 / $2,387.98 / $2,592.15
| Professional | | $1,697.62 | $2,387.98 | $2,592.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,970.03 / $2,885.21 / $4,031.00
| Professional | | $1,970.03 | $2,885.21 | $4,031.00 |