- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.66 / $1,296.41 / $1,456.26
| Professional | | $989.66 | $1,296.41 | $1,456.26 |
- 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
- $1,373.95 / $1,616.41 / $2,467.96
| Professional | | $1,373.95 | $1,616.41 | $2,467.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.81 / $1,889.61 / $2,662.33
| Professional | | $1,347.81 | $1,889.61 | $2,662.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,552.35 / $1,796.07 / $2,755.27
| Professional | | $1,552.35 | $1,796.07 | $2,755.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.66 / $1,456.26 / $1,806.61
| Professional | | $989.66 | $1,456.26 | $1,806.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.63 / $1,698.49 / $2,457.75
| Professional | | $1,192.63 | $1,698.49 | $2,457.75 |