- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.77 / $1,151.77 / $1,307.43
| Professional | | $1,151.77 | $1,151.77 | $1,307.43 |
- 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
- $1,086.17 / $1,195.58 / $1,837.17
| Professional | | $1,086.17 | $1,195.58 | $1,837.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.30 / $1,343.79 / $1,925.21
| Professional | | $1,072.30 | $1,343.79 | $1,925.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.07 / $1,286.72 / $1,973.90
| Professional | | $999.07 | $1,286.72 | $1,973.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.77 / $1,151.77 / $1,307.43
| Professional | | $1,151.77 | $1,151.77 | $1,307.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.37 / $1,273.52 / $1,782.08
| Professional | | $903.37 | $1,273.52 | $1,782.08 |