- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.42 / $1,158.42 / $1,303.47
| Professional | | $1,158.42 | $1,158.42 | $1,303.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,065.14 / $15,647.20 / $17,644.18
| Facility | | $12,065.14 | $15,647.20 | $17,644.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.40 / $1,200.78 / $1,843.31
| Professional | | $1,089.40 | $1,200.78 | $1,843.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.42 / $1,348.37 / $1,931.77
| Professional | | $1,080.42 | $1,348.37 | $1,931.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.40 / $1,291.02 / $1,980.49
| Professional | | $1,002.40 | $1,291.02 | $1,980.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.42 / $1,158.42 / $1,303.47
| Professional | | $1,158.42 | $1,158.42 | $1,303.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.74 / $1,330.35 / $1,786.88
| Professional | | $960.74 | $1,330.35 | $1,786.88 |