- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.50 / $2,039.09 / $2,481.51
| Professional | | $1,380.50 | $2,039.09 | $2,481.51 |
- 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
- $2,130.61 / $2,757.26 / $3,931.43
| Professional | | $2,130.61 | $2,757.26 | $3,931.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,095.38 / $2,977.81 / $4,255.60
| Professional | | $2,095.38 | $2,977.81 | $4,255.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,567.59 / $2,970.70 / $4,557.22
| Professional | | $2,567.59 | $2,970.70 | $4,557.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.50 / $1,796.98 / $2,481.51
| Professional | | $1,380.50 | $1,796.98 | $2,481.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.16 / $2,545.94 / $3,953.11
| Professional | | $1,815.16 | $2,545.94 | $3,953.11 |