- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.70 / $1,612.30 / $2,378.12
| Professional | | $1,401.70 | $1,612.30 | $2,378.12 |
- 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
- $1,606.51 / $2,079.02 / $3,209.80
| Professional | | $1,606.51 | $2,079.02 | $3,209.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,695.32 / $2,383.76 / $3,348.75
| Professional | | $1,695.32 | $2,383.76 | $3,348.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,018.96 / $2,335.94 / $3,583.45
| Professional | | $2,018.96 | $2,335.94 | $3,583.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.70 / $1,807.62 / $2,378.12
| Professional | | $1,401.70 | $1,807.62 | $2,378.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,480.38 / $2,071.09 / $3,108.12
| Professional | | $1,480.38 | $2,071.09 | $3,108.12 |