- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.72 / $1,401.33 / $1,567.17
| Professional | | $1,107.72 | $1,401.33 | $1,567.17 |
- 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
- $1,546.89 / $1,819.87 / $2,785.81
| Professional | | $1,546.89 | $1,819.87 | $2,785.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.03 / $2,026.52 / $2,903.75
| Professional | | $1,470.03 | $2,026.52 | $2,903.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.26 / $2,027.36 / $3,110.09
| Professional | | $1,752.26 | $2,027.36 | $3,110.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.72 / $1,567.17 / $1,692.60
| Professional | | $1,107.72 | $1,567.17 | $1,692.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.46 / $1,875.42 / $2,699.19
| Professional | | $1,283.46 | $1,875.42 | $2,699.19 |