- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.21 / $1,008.46 / $1,217.27
| Professional | | $806.21 | $1,008.46 | $1,217.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,700.76 / $80,886.58 / $94,079.63
| Facility | | $63,700.76 | $80,886.58 | $94,079.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.29 / $1,308.73 / $1,856.22
| Professional | | $1,011.29 | $1,308.73 | $1,856.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.53 / $1,460.73 / $2,078.14
| Professional | | $988.53 | $1,460.73 | $2,078.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.28 / $1,402.61 / $2,151.67
| Professional | | $1,212.28 | $1,402.61 | $2,151.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.21 / $1,051.24 / $1,217.27
| Professional | | $806.21 | $1,051.24 | $1,217.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.13 / $1,311.32 / $2,076.38
| Professional | | $925.13 | $1,311.32 | $2,076.38 |