- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.30 / $1,788.43 / $2,008.38
| Professional | | $1,425.30 | $1,788.43 | $2,008.38 |
- 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
- $1,677.85 / $1,857.09 / $2,838.84
| Professional | | $1,677.85 | $1,857.09 | $2,838.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,658.65 / $2,079.21 / $2,978.84
| Professional | | $1,658.65 | $2,079.21 | $2,978.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.78 / $1,988.26 / $3,050.09
| Professional | | $1,543.78 | $1,988.26 | $3,050.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.30 / $1,788.43 / $2,008.38
| Professional | | $1,425.30 | $1,788.43 | $2,008.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.05 / $1,988.26 / $2,749.65
| Professional | | $1,404.05 | $1,988.26 | $2,749.65 |