- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,069.17 / $2,555.48 / $3,134.48
| Professional | | $2,069.17 | $2,555.48 | $3,134.48 |
- 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
- $2,584.89 / $3,345.15 / $4,714.25
| Professional | | $2,584.89 | $3,345.15 | $4,714.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.15 / $3,738.28 / $5,292.92
| Professional | | $2,493.15 | $3,738.28 | $5,292.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,077.90 / $3,561.13 / $5,462.96
| Professional | | $3,077.90 | $3,561.13 | $5,462.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,069.17 / $3,074.75 / $3,134.48
| Professional | | $2,069.17 | $3,074.75 | $3,134.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,382.19 / $3,663.03 / $4,905.84
| Professional | | $2,382.19 | $3,663.03 | $4,905.84 |