- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.81 / $1,972.03 / $2,397.19
| Professional | | $1,645.81 | $1,972.03 | $2,397.19 |
- 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
- $2,059.31 / $2,664.99 / $3,802.05
| Professional | | $2,059.31 | $2,664.99 | $3,802.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,027.00 / $2,912.96 / $4,114.43
| Professional | | $2,027.00 | $2,912.96 | $4,114.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,483.09 / $2,872.94 / $4,407.24
| Professional | | $2,483.09 | $2,872.94 | $4,407.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.81 / $2,190.94 / $2,397.19
| Professional | | $1,645.81 | $2,190.94 | $2,397.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,853.25 / $2,709.22 / $3,823.74
| Professional | | $1,853.25 | $2,709.22 | $3,823.74 |