- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.00 / $1,734.92 / $2,286.03
| Professional | | $1,656.00 | $1,734.92 | $2,286.03 |
- 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
- $1,912.10 / $2,474.48 / $3,515.01
| Professional | | $1,912.10 | $2,474.48 | $3,515.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.95 / $2,723.88 / $3,875.38
| Professional | | $1,847.95 | $2,723.88 | $3,875.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,275.34 / $2,632.57 / $4,038.50
| Professional | | $2,275.34 | $2,632.57 | $4,038.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.75 / $1,665.66 / $2,286.03
| Professional | | $1,521.75 | $1,665.66 | $2,286.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.38 / $2,463.59 / $3,652.83
| Professional | | $1,737.38 | $2,463.59 | $3,652.83 |