- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $2,454.71
| Professional | | $1,096.48 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $13,182.57 / $17,782.79
| Facility | | $12,302.69 | $13,182.57 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $2,290.87
| Professional | | $977.24 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $2,398.83
| Professional | | $1,258.93 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,479.11 / $2,187.76
| Professional | | $1,202.26 | $1,479.11 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $3,467.37
| Professional | | $1,096.48 | $1,548.82 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,621.81 / $2,187.76
| Professional | | $1,096.48 | $1,621.81 | $2,187.76 |