- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.34 / $1,411.78 / $1,411.78
| Professional | | $1,072.34 | $1,411.78 | $1,411.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,671.44 / $51,449.63 / $58,015.97
| Facility | | $39,671.44 | $51,449.63 | $58,015.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.29 / $1,240.99 / $1,825.53
| Professional | | $1,005.29 | $1,240.99 | $1,825.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.06 / $1,475.84 / $2,046.89
| Professional | | $1,205.06 | $1,475.84 | $2,046.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.24 / $1,184.66 / $1,843.33
| Professional | | $1,064.24 | $1,184.66 | $1,843.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.34 / $1,411.78 / $1,411.78
| Professional | | $1,072.34 | $1,411.78 | $1,411.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.33 / $1,383.10 / $1,856.09
| Professional | | $1,087.33 | $1,383.10 | $1,856.09 |