- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.64 / $1,658.91 / $2,028.77
| Professional | | $1,339.64 | $1,658.91 | $2,028.77 |
- 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
- $1,675.25 / $2,167.96 / $3,059.19
| Professional | | $1,675.25 | $2,167.96 | $3,059.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,620.46 / $2,428.73 / $3,432.62
| Professional | | $1,620.46 | $2,428.73 | $3,432.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,997.93 / $2,311.60 / $3,546.13
| Professional | | $1,997.93 | $2,311.60 | $3,546.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,339.64 / $1,831.44 / $2,028.77
| Professional | | $1,339.64 | $1,831.44 | $2,028.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.86 / $2,183.86 / $3,160.31
| Professional | | $1,554.86 | $2,183.86 | $3,160.31 |