- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.78 / $2,189.03 / $2,189.03
| Professional | | $1,596.78 | $2,189.03 | $2,189.03 |
- 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
- $1,523.47 / $1,867.96 / $2,877.86
| Professional | | $1,523.47 | $1,867.96 | $2,877.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.10 / $2,189.03 / $3,055.84
| Professional | | $1,842.10 | $2,189.03 | $3,055.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.92 / $1,783.18 / $2,774.63
| Professional | | $1,601.92 | $1,783.18 | $2,774.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.78 / $2,189.03 / $2,189.03
| Professional | | $1,596.78 | $2,189.03 | $2,189.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,686.45 / $2,175.28 / $2,767.65
| Professional | | $1,686.45 | $2,175.28 | $2,767.65 |