- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,766.40 / $2,067.42 / $2,530.05
| Professional | | $1,766.40 | $2,067.42 | $2,530.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,569.01 / $56,593.28 / $65,823.96
| Facility | | $44,569.01 | $56,593.28 | $65,823.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.01 / $2,805.67 / $3,992.65
| Professional | | $2,168.01 | $2,805.67 | $3,992.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,124.38 / $3,048.67 / $4,322.45
| Professional | | $2,124.38 | $3,048.67 | $4,322.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,607.58 / $3,016.97 / $4,628.18
| Professional | | $2,607.58 | $3,016.97 | $4,628.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.77 / $2,101.71 / $2,530.05
| Professional | | $1,734.77 | $2,101.71 | $2,530.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,922.84 / $2,834.65 / $4,007.97
| Professional | | $1,922.84 | $2,834.65 | $4,007.97 |