- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.94 / $1,774.97 / $2,000.15
| Professional | | $1,418.94 | $1,774.97 | $2,000.15 |
- 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
- $1,666.50 / $1,842.37 / $2,818.41
| Professional | | $1,666.50 | $1,842.37 | $2,818.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,654.61 / $2,065.73 / $2,959.52
| Professional | | $1,654.61 | $2,065.73 | $2,959.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.67 / $1,973.96 / $3,028.16
| Professional | | $1,532.67 | $1,973.96 | $3,028.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.94 / $1,774.97 / $2,000.15
| Professional | | $1,418.94 | $1,774.97 | $2,000.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.66 / $2,177.78 / $2,732.25
| Professional | | $1,453.66 | $2,177.78 | $2,732.25 |