- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,698.24 / $4,265.80
| Professional | | $1,412.54 | $1,698.24 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $19,498.45 / $26,302.68
| Facility | | $18,197.01 | $19,498.45 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $2,818.38
| Professional | | $1,230.27 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,905.46 / $3,090.30
| Professional | | $1,584.89 | $1,905.46 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,905.46 / $2,754.23
| Professional | | $1,548.82 | $1,905.46 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $4,365.16
| Professional | | $1,412.54 | $1,905.46 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,995.26 / $2,754.23
| Professional | | $1,380.38 | $1,995.26 | $2,754.23 |