- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,413.25 / $2,413.25 / $2,953.34
| Professional | | $2,413.25 | $2,413.25 | $2,953.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,990.11 / $32,409.51 / $36,545.83
| Facility | | $24,990.11 | $32,409.51 | $36,545.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,519.21 / $2,884.90 / $4,256.37
| Professional | | $2,519.21 | $2,884.90 | $4,256.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,331.38 / $2,953.02 / $4,440.60
| Professional | | $2,331.38 | $2,953.02 | $4,440.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.10 / $3,097.57 / $4,751.83
| Professional | | $2,405.10 | $3,097.57 | $4,751.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,413.25 / $2,413.25 / $2,953.34
| Professional | | $2,413.25 | $2,413.25 | $2,953.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,217.44 / $3,022.97 / $4,112.52
| Professional | | $2,217.44 | $3,022.97 | $4,112.52 |