- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,837.68 / $2,276.92 / $2,781.18
| Professional | | $1,837.68 | $2,276.92 | $2,781.18 |
- 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
- $2,298.62 / $2,974.69 / $4,197.30
| Professional | | $2,298.62 | $2,974.69 | $4,197.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,223.79 / $3,332.72 / $4,710.49
| Professional | | $2,223.79 | $3,332.72 | $4,710.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,741.13 / $3,171.49 / $4,865.22
| Professional | | $2,741.13 | $3,171.49 | $4,865.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,837.68 / $2,557.28 / $2,781.18
| Professional | | $1,837.68 | $2,557.28 | $2,781.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.69 / $3,182.16 / $4,744.02
| Professional | | $2,113.69 | $3,182.16 | $4,744.02 |