- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.88 / $2,076.94 / $2,554.69
| Professional | | $1,677.88 | $2,076.94 | $2,554.69 |
- 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
- $2,098.13 / $2,715.22 / $3,829.81
| Professional | | $2,098.13 | $2,715.22 | $3,829.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.13 / $3,039.93 / $4,298.46
| Professional | | $2,028.13 | $3,039.93 | $4,298.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,501.23 / $2,893.92 / $4,439.43
| Professional | | $2,501.23 | $2,893.92 | $4,439.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.88 / $2,339.77 / $2,554.69
| Professional | | $1,677.88 | $2,339.77 | $2,554.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.57 / $2,728.84 / $3,956.05
| Professional | | $1,941.57 | $2,728.84 | $3,956.05 |