- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.44 / $1,965.43 / $1,965.43
| Professional | | $1,521.44 | $1,965.43 | $1,965.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,010.53 / $14,279.49 / $16,101.93
| Facility | | $11,010.53 | $14,279.49 | $16,101.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.51 / $1,679.70 / $2,499.46
| Professional | | $1,368.51 | $1,679.70 | $2,499.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.08 / $1,965.43 / $2,745.74
| Professional | | $1,653.08 | $1,965.43 | $2,745.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.47 / $1,603.46 / $2,494.98
| Professional | | $1,440.47 | $1,603.46 | $2,494.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.44 / $1,965.43 / $1,965.43
| Professional | | $1,521.44 | $1,965.43 | $1,965.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.19 / $1,905.76 / $2,487.71
| Professional | | $1,462.19 | $1,905.76 | $2,487.71 |