- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.85 / $2,316.92 / $2,830.27
| Professional | | $1,628.85 | $2,316.92 | $2,830.27 |
- 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
- $2,291.75 / $2,676.61 / $4,471.70
| Professional | | $2,291.75 | $2,676.61 | $4,471.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.96 / $3,396.33 / $4,841.25
| Professional | | $2,165.96 | $3,396.33 | $4,841.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,920.44 / $3,378.95 / $5,183.49
| Professional | | $2,920.44 | $3,378.95 | $5,183.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,628.85 / $2,197.62 / $2,830.27
| Professional | | $1,628.85 | $2,197.62 | $2,830.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,956.40 / $2,747.11 / $5,520.17
| Professional | | $1,956.40 | $2,747.11 | $5,520.17 |