- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.78 / $2,406.53 / $2,643.34
| Professional | | $1,684.78 | $2,406.53 | $2,643.34 |
- 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
- $1,737.73 / $2,128.34 / $3,175.01
| Professional | | $1,737.73 | $2,128.34 | $3,175.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.89 / $2,630.40 / $3,483.47
| Professional | | $2,099.89 | $2,630.40 | $3,483.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.21 / $2,031.73 / $3,161.37
| Professional | | $1,825.21 | $2,031.73 | $3,161.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.78 / $2,406.53 / $2,643.34
| Professional | | $1,684.78 | $2,406.53 | $2,643.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,871.10 / $2,409.89 / $3,151.23
| Professional | | $1,871.10 | $2,409.89 | $3,151.23 |