- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.75 / $1,366.56 / $1,366.56
| Professional | | $1,360.75 | $1,366.56 | $1,366.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,783.47 / $23,063.27 / $26,006.75
| Facility | | $17,783.47 | $23,063.27 | $26,006.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.16 / $1,440.69 / $2,228.71
| Professional | | $1,272.16 | $1,440.69 | $2,228.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.47 / $1,616.96 / $2,316.58
| Professional | | $1,304.47 | $1,616.96 | $2,316.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.99 / $1,560.94 / $2,394.57
| Professional | | $1,211.99 | $1,560.94 | $2,394.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.75 / $1,366.56 / $1,366.56
| Professional | | $1,360.75 | $1,366.56 | $1,366.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.92 / $1,488.44 / $2,113.66
| Professional | | $1,105.92 | $1,488.44 | $2,113.66 |