- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.81 / $1,701.76 / $2,075.60
| Professional | | $1,371.81 | $1,701.76 | $2,075.60 |
- 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
- $1,715.49 / $2,220.05 / $3,137.45
| Professional | | $1,715.49 | $2,220.05 | $3,137.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.13 / $2,490.71 / $3,517.66
| Professional | | $1,664.13 | $2,490.71 | $3,517.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.05 / $2,370.75 / $3,636.86
| Professional | | $2,049.05 | $2,370.75 | $3,636.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.81 / $1,921.93 / $2,075.60
| Professional | | $1,371.81 | $1,921.93 | $2,075.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,577.46 / $2,243.33 / $3,243.80
| Professional | | $1,577.46 | $2,243.33 | $3,243.80 |