- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.73 / $1,967.73 / $2,290.60
| Professional | | $1,518.73 | $1,967.73 | $2,290.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,491.08 / $26,019.37 / $30,263.27
| Facility | | $20,491.08 | $26,019.37 | $30,263.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.15 / $2,444.79 / $3,446.34
| Professional | | $1,889.15 | $2,444.79 | $3,446.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.76 / $2,743.19 / $3,915.49
| Professional | | $1,808.76 | $2,743.19 | $3,915.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,233.71 / $2,584.40 / $3,964.61
| Professional | | $2,233.71 | $2,584.40 | $3,964.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.73 / $2,290.60 / $2,308.87
| Professional | | $1,518.73 | $2,290.60 | $2,308.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.86 / $2,660.01 / $3,694.46
| Professional | | $1,740.86 | $2,660.01 | $3,694.46 |