- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,594.14 / $1,828.87 / $2,233.05
| Professional | | $1,594.14 | $1,828.87 | $2,233.05 |
- 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 / $3,374.12
| Professional | | $1,844.33 | $2,386.78 | $3,374.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,691.77 / $2,608.32 / $3,781.36
| Professional | | $1,691.77 | $2,608.32 | $3,781.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,203.62 / $2,549.59 / $3,911.21
| Professional | | $2,203.62 | $2,549.59 | $3,911.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,594.14 / $2,233.05 / $2,421.64
| Professional | | $1,594.14 | $2,233.05 | $2,421.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.47 / $2,477.85 / $3,204.11
| Professional | | $1,518.47 | $2,477.85 | $3,204.11 |