- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.12 / $1,331.12 / $2,313.41
| Professional | | $1,331.12 | $1,331.12 | $2,313.41 |
- 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
- $1,536.35 / $1,772.40 / $2,789.07
| Professional | | $1,536.35 | $1,772.40 | $2,789.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.85 / $1,992.33 / $2,854.36
| Professional | | $1,603.85 | $1,992.33 | $2,854.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,478.61 / $1,904.32 / $2,921.33
| Professional | | $1,478.61 | $1,904.32 | $2,921.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.12 / $1,331.12 / $2,313.41
| Professional | | $1,331.12 | $1,331.12 | $2,313.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.63 / $1,893.69 / $2,633.44
| Professional | | $1,426.63 | $1,893.69 | $2,633.44 |