- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.29 / $1,158.35 / $1,769.14
| Professional | | $1,063.29 | $1,158.35 | $1,769.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49,765.08 / $49,765.08 / $61,017.68
| Facility | | $49,765.08 | $49,765.08 | $61,017.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.95 / $1,938.77 / $3,262.70
| Professional | | $1,538.95 | $1,938.77 | $3,262.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.95 / $1,938.77 / $3,262.70
| Professional | | $1,538.95 | $1,938.77 | $3,262.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,476.65 / $1,585.58 / $4,004.60
| Professional | | $1,476.65 | $1,585.58 | $4,004.60 |