- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.44 / $1,272.49 / $1,537.76
| Professional | | $1,018.44 | $1,272.49 | $1,537.76 |
- 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
- $1,277.79 / $1,653.61 / $2,340.94
| Professional | | $1,277.79 | $1,653.61 | $2,340.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.38 / $1,845.31 / $2,624.26
| Professional | | $1,245.38 | $1,845.31 | $2,624.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,528.85 / $1,768.88 / $2,713.56
| Professional | | $1,528.85 | $1,768.88 | $2,713.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.44 / $1,408.28 / $1,537.76
| Professional | | $1,018.44 | $1,408.28 | $1,537.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,168.03 / $1,635.24 / $2,424.92
| Professional | | $1,168.03 | $1,635.24 | $2,424.92 |