- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.94 / $1,687.21 / $2,047.23
| Professional | | $1,355.94 | $1,687.21 | $2,047.23 |
- 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
- $1,698.55 / $2,198.13 / $3,104.62
| Professional | | $1,698.55 | $2,198.13 | $3,104.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,648.21 / $2,456.67 / $3,484.88
| Professional | | $1,648.21 | $2,456.67 | $3,484.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,027.61 / $2,345.94 / $3,598.80
| Professional | | $2,027.61 | $2,345.94 | $3,598.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.94 / $1,853.22 / $2,047.23
| Professional | | $1,355.94 | $1,853.22 | $2,047.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.71 / $2,168.19 / $3,212.41
| Professional | | $1,548.71 | $2,168.19 | $3,212.41 |