- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.32 / $1,305.64 / $1,726.12
| Professional | | $1,028.32 | $1,305.64 | $1,726.12 |
- 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
- $1,399.24 / $1,680.76 / $2,518.44
| Professional | | $1,399.24 | $1,680.76 | $2,518.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.34 / $1,688.33 / $2,627.09
| Professional | | $1,331.34 | $1,688.33 | $2,627.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.06 / $1,832.78 / $2,811.58
| Professional | | $1,423.06 | $1,832.78 | $2,811.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.32 / $1,305.64 / $1,726.12
| Professional | | $1,028.32 | $1,305.64 | $1,726.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.21 / $1,714.02 / $2,421.69
| Professional | | $1,221.21 | $1,714.02 | $2,421.69 |