- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.96 / $2,002.96 / $2,117.14
| Professional | | $2,002.96 | $2,002.96 | $2,117.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,671.44 / $51,449.63 / $58,015.97
| Facility | | $39,671.44 | $51,449.63 | $58,015.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.20 / $2,535.15 / $3,042.80
| Professional | | $1,730.20 | $2,535.15 | $3,042.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.41 / $1,915.08 / $2,979.86
| Professional | | $1,720.41 | $1,915.08 | $2,979.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.96 / $2,002.96 / $2,117.14
| Professional | | $2,002.96 | $2,002.96 | $2,117.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.09 / $3,053.82 / $3,340.12
| Professional | | $2,137.09 | $3,053.82 | $3,340.12 |