- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.37 / $1,744.29 / $2,094.19
| Professional | | $1,483.37 | $1,744.29 | $2,094.19 |
- 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
- $1,838.90 / $2,321.55 / $3,725.55
| Professional | | $1,838.90 | $2,321.55 | $3,725.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.61 / $2,769.63 / $3,890.55
| Professional | | $1,969.61 | $2,769.63 | $3,890.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,343.36 / $2,711.27 / $4,159.22
| Professional | | $2,343.36 | $2,711.27 | $4,159.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.37 / $2,094.19 / $2,542.08
| Professional | | $1,483.37 | $2,094.19 | $2,542.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,632.31 / $2,366.85 / $3,612.51
| Professional | | $1,632.31 | $2,366.85 | $3,612.51 |