- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,498.56 / $1,888.03 / $2,118.44
| Professional | | $1,498.56 | $1,888.03 | $2,118.44 |
- 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
- $1,890.06 / $2,445.96 / $3,751.11
| Professional | | $1,890.06 | $2,445.96 | $3,751.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,981.31 / $2,781.07 / $3,913.67
| Professional | | $1,981.31 | $2,781.07 | $3,913.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,359.42 / $2,729.86 / $4,187.75
| Professional | | $2,359.42 | $2,729.86 | $4,187.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,498.56 / $2,118.44 / $2,568.01
| Professional | | $1,498.56 | $2,118.44 | $2,568.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.94 / $2,482.16 / $3,628.65
| Professional | | $1,734.94 | $2,482.16 | $3,628.65 |