- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,005.14 / $2,883.14 / $3,510.33
| Professional | | $2,005.14 | $2,883.14 | $3,510.33 |
- 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
- $2,907.87 / $3,763.13 / $5,301.02
| Professional | | $2,907.87 | $3,763.13 | $5,301.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,810.24 / $4,097.64 / $5,961.34
| Professional | | $2,810.24 | $4,097.64 | $5,961.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,462.07 / $4,005.62 / $6,144.83
| Professional | | $3,462.07 | $4,005.62 | $6,144.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,005.14 / $2,788.32 / $3,510.33
| Professional | | $2,005.14 | $2,788.32 | $3,510.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,435.66 / $3,524.48 / $5,483.36
| Professional | | $2,435.66 | $3,524.48 | $5,483.36 |