- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.53 / $1,225.53 / $1,370.18
| Professional | | $1,225.53 | $1,225.53 | $1,370.18 |
- 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
- $1,141.64 / $1,272.86 / $1,932.50
| Professional | | $1,141.64 | $1,272.86 | $1,932.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.04 / $1,433.04 / $2,053.08
| Professional | | $1,129.04 | $1,433.04 | $2,053.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.91 / $1,353.48 / $2,076.31
| Professional | | $1,050.91 | $1,353.48 | $2,076.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.53 / $1,225.53 / $1,370.18
| Professional | | $1,225.53 | $1,225.53 | $1,370.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.65 / $1,350.39 / $1,873.05
| Professional | | $957.65 | $1,350.39 | $1,873.05 |