- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.76 / $1,268.52 / $1,532.86
| Professional | | $1,013.76 | $1,268.52 | $1,532.86 |
- 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
- $1,271.44 / $1,645.40 / $2,338.41
| Professional | | $1,271.44 | $1,645.40 | $2,338.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.97 / $1,839.43 / $2,613.23
| Professional | | $1,245.97 | $1,839.43 | $2,613.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,527.20 / $1,766.97 / $2,710.63
| Professional | | $1,527.20 | $1,766.97 | $2,710.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.76 / $1,406.06 / $1,532.86
| Professional | | $1,013.76 | $1,406.06 | $1,532.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.02 / $1,624.03 / $2,424.30
| Professional | | $1,160.02 | $1,624.03 | $2,424.30 |