- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.27 / $1,775.03 / $2,163.27
| Professional | | $1,399.27 | $1,775.03 | $2,163.27 |
- 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
- $1,775.15 / $2,297.26 / $3,229.59
| Professional | | $1,775.15 | $2,297.26 | $3,229.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,714.78 / $2,578.12 / $3,658.07
| Professional | | $1,714.78 | $2,578.12 | $3,658.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,109.23 / $2,440.38 / $3,743.67
| Professional | | $2,109.23 | $2,440.38 | $3,743.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,399.27 / $1,953.59 / $2,163.27
| Professional | | $1,399.27 | $1,953.59 | $2,163.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.39 / $2,188.41 / $3,354.27
| Professional | | $1,556.39 | $2,188.41 | $3,354.27 |