- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.72 / $1,298.47 / $1,576.37
| Professional | | $1,042.72 | $1,298.47 | $1,576.37 |
- 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
- $1,305.68 / $1,689.71 / $2,392.07
| Professional | | $1,305.68 | $1,689.71 | $2,392.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,271.24 / $1,891.64 / $2,680.07
| Professional | | $1,271.24 | $1,891.64 | $2,680.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,562.24 / $1,807.51 / $2,772.82
| Professional | | $1,562.24 | $1,807.51 | $2,772.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.72 / $1,438.14 / $1,576.37
| Professional | | $1,042.72 | $1,438.14 | $1,576.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.28 / $1,701.06 / $2,508.02
| Professional | | $1,189.28 | $1,701.06 | $2,508.02 |