- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.91 / $2,262.84 / $2,762.20
| Professional | | $1,872.91 | $2,262.84 | $2,762.20 |
- 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
- $2,238.05 / $2,746.77 / $4,366.92
| Professional | | $2,238.05 | $2,746.77 | $4,366.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.98 / $3,314.64 / $4,727.31
| Professional | | $2,114.98 | $3,314.64 | $4,727.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,852.01 / $3,299.78 / $5,062.03
| Professional | | $2,852.01 | $3,299.78 | $5,062.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.91 / $2,346.57 / $2,762.20
| Professional | | $1,872.91 | $2,346.57 | $2,762.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,955.39 / $2,868.93 / $4,386.00
| Professional | | $1,955.39 | $2,868.93 | $4,386.00 |