- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.79 / $1,216.79 / $1,363.16
| Professional | | $1,216.79 | $1,216.79 | $1,363.16 |
- 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
- $1,145.70 / $1,263.21 / $1,939.31
| Professional | | $1,145.70 | $1,263.21 | $1,939.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.03 / $1,418.09 / $2,031.66
| Professional | | $1,131.03 | $1,418.09 | $2,031.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.60 / $1,358.26 / $2,083.64
| Professional | | $1,054.60 | $1,358.26 | $2,083.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.79 / $1,216.79 / $1,363.16
| Professional | | $1,216.79 | $1,216.79 | $1,363.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.53 / $1,346.37 / $1,879.33
| Professional | | $954.53 | $1,346.37 | $1,879.33 |