- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.93 / $1,776.79 / $2,138.71
| Professional | | $1,431.93 | $1,776.79 | $2,138.71 |
- 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
- $1,844.33 / $2,386.78 / $3,414.53
| Professional | | $1,844.33 | $2,386.78 | $3,414.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.61 / $2,566.46 / $3,696.04
| Professional | | $1,700.61 | $2,566.46 | $3,696.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,230.00 / $2,580.11 / $3,958.03
| Professional | | $2,230.00 | $2,580.11 | $3,958.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.93 / $1,720.52 / $2,138.71
| Professional | | $1,431.93 | $1,720.52 | $2,138.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.42 / $2,172.94 / $3,469.88
| Professional | | $1,519.42 | $2,172.94 | $3,469.88 |