- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.08 / $1,182.08 / $1,332.42
| Professional | | $1,182.08 | $1,182.08 | $1,332.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,783.47 / $23,063.27 / $26,006.75
| Facility | | $17,783.47 | $23,063.27 | $26,006.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.33 / $1,232.84 / $1,891.66
| Professional | | $1,117.33 | $1,232.84 | $1,891.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.05 / $1,382.77 / $1,981.06
| Professional | | $1,102.05 | $1,382.77 | $1,981.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.69 / $1,324.87 / $2,032.42
| Professional | | $1,028.69 | $1,324.87 | $2,032.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.08 / $1,182.08 / $1,332.42
| Professional | | $1,182.08 | $1,182.08 | $1,332.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.22 / $1,561.70 / $1,833.35
| Professional | | $1,177.22 | $1,561.70 | $1,833.35 |