- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.25 / $936.13 / $1,128.56
| Professional | | $749.25 | $936.13 | $1,128.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,569.01 / $56,593.28 / $65,823.96
| Facility | | $44,569.01 | $56,593.28 | $65,823.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.52 / $1,213.26 / $1,729.35
| Professional | | $937.52 | $1,213.26 | $1,729.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.43 / $1,306.75 / $2,004.63
| Professional | | $1,129.43 | $1,306.75 | $2,004.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.25 / $1,035.54 / $1,128.56
| Professional | | $749.25 | $1,035.54 | $1,128.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.71 / $1,201.47 / $1,792.24
| Professional | | $857.71 | $1,201.47 | $1,792.24 |