- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.45 / $1,374.88 / $1,525.15
| Professional | | $1,095.45 | $1,374.88 | $1,525.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,744.96 / $31,420.90 / $36,545.83
| Facility | | $24,744.96 | $31,420.90 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.19 / $1,726.60 / $2,510.71
| Professional | | $1,334.19 | $1,726.60 | $2,510.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.03 / $1,946.96 / $2,829.57
| Professional | | $1,336.03 | $1,946.96 | $2,829.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,639.73 / $1,897.17 / $2,910.36
| Professional | | $1,639.73 | $1,897.17 | $2,910.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.45 / $1,472.30 / $1,525.15
| Professional | | $1,095.45 | $1,472.30 | $1,525.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,159.10 / $1,652.49 / $2,608.23
| Professional | | $1,159.10 | $1,652.49 | $2,608.23 |