- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.63 / $1,214.74 / $1,472.58
| Professional | | $901.63 | $1,214.74 | $1,472.58 |
- 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
- $1,222.02 / $1,581.44 / $2,238.69
| Professional | | $1,222.02 | $1,581.44 | $2,238.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.27 / $1,767.09 / $2,507.96
| Professional | | $1,189.27 | $1,767.09 | $2,507.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.07 / $1,691.62 / $2,595.03
| Professional | | $1,462.07 | $1,691.62 | $2,595.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.63 / $1,310.50 / $1,472.58
| Professional | | $901.63 | $1,310.50 | $1,472.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.16 / $1,589.74 / $2,316.77
| Professional | | $1,119.16 | $1,589.74 | $2,316.77 |