- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.11 / $2,219.41 / $2,724.51
| Professional | | $1,797.11 | $2,219.41 | $2,724.51 |
- 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
- $2,245.67 / $2,906.17 / $4,095.56
| Professional | | $2,245.67 | $2,906.17 | $4,095.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.79 / $3,247.46 / $4,597.68
| Professional | | $2,165.79 | $3,247.46 | $4,597.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,674.35 / $3,094.22 / $4,746.70
| Professional | | $2,674.35 | $3,094.22 | $4,746.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.11 / $2,526.36 / $2,724.51
| Professional | | $1,797.11 | $2,526.36 | $2,724.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,070.63 / $2,937.91 / $4,226.74
| Professional | | $2,070.63 | $2,937.91 | $4,226.74 |