- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.01 / $1,395.28 / $1,395.28
| Professional | | $694.01 | $1,395.28 | $1,395.28 |
- 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
- $1,305.52 / $1,582.56 / $1,582.56
| Professional | | $1,305.52 | $1,582.56 | $1,582.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,712.69 / $1,981.58 / $3,039.85
| Professional | | $1,712.69 | $1,981.58 | $3,039.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.01 / $1,395.28 / $1,395.28
| Professional | | $694.01 | $1,395.28 | $1,395.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.80 / $1,840.85 / $2,739.19
| Professional | | $1,177.80 | $1,840.85 | $2,739.19 |