- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.52 / $1,189.52 / $2,067.21
| Professional | | $1,189.52 | $1,189.52 | $2,067.21 |
- 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
- $1,382.64 / $1,584.68 / $2,496.40
| Professional | | $1,382.64 | $1,584.68 | $2,496.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.57 / $1,781.74 / $2,552.65
| Professional | | $1,423.57 | $1,781.74 | $2,552.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.45 / $1,704.49 / $2,614.78
| Professional | | $1,323.45 | $1,704.49 | $2,614.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.52 / $1,189.52 / $2,067.21
| Professional | | $1,189.52 | $1,189.52 | $2,067.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.45 / $1,888.30 / $2,358.65
| Professional | | $1,323.45 | $1,888.30 | $2,358.65 |