- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.73 / $1,165.65 / $1,404.69
| Professional | | $931.73 | $1,165.65 | $1,404.69 |
- 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
- $1,168.72 / $1,512.46 / $2,144.65
| Professional | | $1,168.72 | $1,512.46 | $2,144.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.20 / $1,685.63 / $2,401.86
| Professional | | $1,142.20 | $1,685.63 | $2,401.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,400.66 / $1,620.56 / $2,486.03
| Professional | | $1,400.66 | $1,620.56 | $2,486.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.73 / $1,287.30 / $1,404.69
| Professional | | $931.73 | $1,287.30 | $1,404.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.56 / $1,513.19 / $2,248.62
| Professional | | $1,067.56 | $1,513.19 | $2,248.62 |