- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.01 / $1,647.81 / $2,233.51
| Professional | | $1,475.01 | $1,647.81 | $2,233.51 |
- 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
- $1,845.04 / $2,387.69 / $3,334.99
| Professional | | $1,845.04 | $2,387.69 | $3,334.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,766.88 / $2,648.23 / $3,783.10
| Professional | | $1,766.88 | $2,648.23 | $3,783.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,178.06 / $2,520.02 / $3,865.84
| Professional | | $2,178.06 | $2,520.02 | $3,865.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.94 / $1,666.37 / $2,233.51
| Professional | | $1,399.94 | $1,666.37 | $2,233.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,697.47 / $2,586.67 / $3,478.76
| Professional | | $1,697.47 | $2,586.67 | $3,478.76 |