- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,742.87 / $1,742.87 / $2,126.09
| Professional | | $1,742.87 | $1,742.87 | $2,126.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,990.11 / $32,409.51 / $36,545.83
| Facility | | $24,990.11 | $32,409.51 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.33 / $2,093.08 / $3,091.84
| Professional | | $1,826.33 | $2,093.08 | $3,091.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.24 / $2,145.42 / $3,229.28
| Professional | | $1,644.24 | $2,145.42 | $3,229.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,747.08 / $2,250.09 / $3,451.75
| Professional | | $1,747.08 | $2,250.09 | $3,451.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,742.87 / $1,742.87 / $2,126.09
| Professional | | $1,742.87 | $1,742.87 | $2,126.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.50 / $2,182.80 / $3,232.69
| Professional | | $1,584.50 | $2,182.80 | $3,232.69 |