- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.83 / $1,444.63 / $1,640.81
| Professional | | $1,164.83 | $1,444.63 | $1,640.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,065.14 / $15,647.20 / $17,644.18
| Facility | | $12,065.14 | $15,647.20 | $17,644.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.10 / $1,501.04 / $2,294.77
| Professional | | $1,357.10 | $1,501.04 | $2,294.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.38 / $1,681.10 / $2,408.46
| Professional | | $1,406.38 | $1,681.10 | $2,408.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.91 / $1,607.20 / $2,465.53
| Professional | | $1,247.91 | $1,607.20 | $2,465.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.83 / $1,444.63 / $1,640.81
| Professional | | $1,164.83 | $1,444.63 | $1,640.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,324.66 / $1,672.53 / $2,230.04
| Professional | | $1,324.66 | $1,672.53 | $2,230.04 |