- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.22 / $1,734.10 / $1,942.03
| Professional | | $1,372.22 | $1,734.10 | $1,942.03 |
- 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
- $1,762.20 / $2,073.17 / $3,441.79
| Professional | | $1,762.20 | $2,073.17 | $3,441.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.73 / $2,553.03 / $3,586.60
| Professional | | $1,815.73 | $2,553.03 | $3,586.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,164.87 / $2,504.75 / $3,842.43
| Professional | | $2,164.87 | $2,504.75 | $3,842.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.22 / $1,942.03 / $2,383.12
| Professional | | $1,372.22 | $1,942.03 | $2,383.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,501.46 / $2,286.63 / $3,569.64
| Professional | | $1,501.46 | $2,286.63 | $3,569.64 |