- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,400.01 / $1,518.55 / $1,518.55
| Professional | | $1,400.01 | $1,518.55 | $1,518.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,268.63 / $22,395.57 / $25,253.84
| Facility | | $17,268.63 | $22,395.57 | $25,253.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.71 / $2,029.76 / $2,931.94
| Professional | | $1,718.71 | $2,029.76 | $2,931.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,643.26 / $2,183.38 / $3,300.05
| Professional | | $1,643.26 | $2,183.38 | $3,300.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.19 / $2,200.01 / $3,374.94
| Professional | | $1,708.19 | $2,200.01 | $3,374.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.60 / $1,518.55 / $1,518.55
| Professional | | $1,231.60 | $1,518.55 | $1,518.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,516.19 / $2,106.46 / $3,047.25
| Professional | | $1,516.19 | $2,106.46 | $3,047.25 |