- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,308.67 / $2,308.67 / $2,576.04
| Professional | | $2,308.67 | $2,308.67 | $2,576.04 |
- 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
- $2,162.61 / $2,398.21 / $3,658.69
| Professional | | $2,162.61 | $2,398.21 | $3,658.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,166.51 / $2,682.31 / $3,842.88
| Professional | | $2,166.51 | $2,682.31 | $3,842.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,989.62 / $2,562.46 / $3,930.96
| Professional | | $1,989.62 | $2,562.46 | $3,930.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,308.67 / $2,308.67 / $2,576.04
| Professional | | $2,308.67 | $2,308.67 | $2,576.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,214.75 / $2,991.24 / $3,542.60
| Professional | | $2,214.75 | $2,991.24 | $3,542.60 |