- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.35 / $960.35 / $1,027.58
| Professional | | $960.35 | $960.35 | $1,027.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,268.63 / $22,395.57 / $25,253.84
| Facility | | $17,268.63 | $22,395.57 | $25,253.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.40 / $1,270.42 / $1,835.09
| Professional | | $1,060.40 | $1,270.42 | $1,835.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.31 / $1,368.96 / $2,075.64
| Professional | | $1,076.31 | $1,368.96 | $2,075.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.20 / $1,374.47 / $2,108.51
| Professional | | $1,067.20 | $1,374.47 | $2,108.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.35 / $960.35 / $1,027.58
| Professional | | $960.35 | $960.35 | $1,027.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.48 / $1,459.62 / $2,066.26
| Professional | | $987.48 | $1,459.62 | $2,066.26 |