- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,491.27 / $3,491.27 / $4,273.66
| Professional | | $3,491.27 | $3,491.27 | $4,273.66 |
- 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
- $3,718.80 / $4,160.89 / $6,129.96
| Professional | | $3,718.80 | $4,160.89 | $6,129.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,458.36 / $4,253.35 / $6,394.19
| Professional | | $3,458.36 | $4,253.35 | $6,394.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,463.79 / $4,461.07 / $6,843.52
| Professional | | $3,463.79 | $4,461.07 | $6,843.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,491.27 / $3,491.27 / $4,273.66
| Professional | | $3,491.27 | $3,491.27 | $4,273.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,266.67 / $4,675.09 / $6,843.52
| Professional | | $3,266.67 | $4,675.09 | $6,843.52 |