- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.55 / $1,155.41 / $1,378.62
| Professional | | $947.55 | $1,155.41 | $1,378.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,744.96 / $31,420.90 / $36,545.83
| Facility | | $24,744.96 | $31,420.90 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.31 / $1,541.70 / $2,211.55
| Professional | | $1,191.31 | $1,541.70 | $2,211.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,155.51 / $1,701.79 / $2,395.42
| Professional | | $1,155.51 | $1,701.79 | $2,395.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.35 / $1,671.11 / $2,563.58
| Professional | | $1,444.35 | $1,671.11 | $2,563.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.66 / $1,193.84 / $1,378.62
| Professional | | $986.66 | $1,193.84 | $1,378.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.82 / $1,379.53 / $2,247.41
| Professional | | $971.82 | $1,379.53 | $2,247.41 |