- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.86 / $2,835.45 / $3,461.55
| Professional | | $2,256.86 | $2,835.45 | $3,461.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,700.76 / $80,886.58 / $94,079.63
| Facility | | $63,700.76 | $80,886.58 | $94,079.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,861.98 / $3,703.74 / $5,224.02
| Professional | | $2,861.98 | $3,703.74 | $5,224.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,767.92 / $4,037.21 / $5,865.55
| Professional | | $2,767.92 | $4,037.21 | $5,865.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,411.78 / $3,947.43 / $6,055.57
| Professional | | $3,411.78 | $3,947.43 | $6,055.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.86 / $2,713.47 / $3,461.55
| Professional | | $2,256.86 | $2,713.47 | $3,461.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,353.85 / $3,399.25 / $5,400.94
| Professional | | $2,353.85 | $3,399.25 | $5,400.94 |