- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.80 / $1,616.33 / $1,808.72
| Professional | | $1,277.80 | $1,616.33 | $1,808.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,744.96 / $31,420.90 / $36,545.83
| Facility | | $24,744.96 | $31,420.90 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.51 / $2,085.31 / $3,207.84
| Professional | | $1,772.51 | $2,085.31 | $3,207.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,693.03 / $2,381.77 / $3,344.24
| Professional | | $1,693.03 | $2,381.77 | $3,344.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.72 / $2,334.50 / $3,581.25
| Professional | | $2,017.72 | $2,334.50 | $3,581.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.80 / $1,808.72 / $2,201.75
| Professional | | $1,277.80 | $1,808.72 | $2,201.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.28 / $2,110.65 / $3,324.61
| Professional | | $1,481.28 | $2,110.65 | $3,324.61 |