- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.23 / $1,810.23 / $1,845.31
| Professional | | $1,810.23 | $1,810.23 | $1,845.31 |
- 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
- $1,887.04 / $2,364.08 / $3,511.84
| Professional | | $1,887.04 | $2,364.08 | $3,511.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,056.96 / $2,560.77 / $3,857.64
| Professional | | $2,056.96 | $2,560.77 | $3,857.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,038.87 / $2,625.89 / $4,028.26
| Professional | | $2,038.87 | $2,625.89 | $4,028.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,810.23 / $1,810.23 / $1,845.31
| Professional | | $1,810.23 | $1,810.23 | $1,845.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.39 / $2,533.21 / $3,548.66
| Professional | | $1,797.39 | $2,533.21 | $3,548.66 |