- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,692.68 / $1,942.27 / $2,465.25
| Professional | | $1,692.68 | $1,942.27 | $2,465.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,010.53 / $14,279.49 / $16,101.93
| Facility | | $11,010.53 | $14,279.49 | $16,101.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,714.09 / $2,101.57 / $3,262.25
| Professional | | $1,714.09 | $2,101.57 | $3,262.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.00 / $2,465.25 / $3,436.99
| Professional | | $2,028.00 | $2,465.25 | $3,436.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.25 / $2,006.18 / $3,121.62
| Professional | | $1,802.25 | $2,006.18 | $3,121.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,535.69 / $1,942.27 / $2,465.25
| Professional | | $1,535.69 | $1,942.27 | $2,465.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.65 / $2,470.71 / $3,110.53
| Professional | | $1,737.65 | $2,470.71 | $3,110.53 |