- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.28 / $1,580.28 / $1,917.48
| Professional | | $1,580.28 | $1,580.28 | $1,917.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,694.09 / $26,838.03 / $30,263.27
| Facility | | $20,694.09 | $26,838.03 | $30,263.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.29 / $2,156.54 / $3,115.05
| Professional | | $1,832.29 | $2,156.54 | $3,115.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,980.08 / $2,320.50 / $3,556.05
| Professional | | $1,980.08 | $2,320.50 | $3,556.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.17 / $2,328.77 / $3,572.47
| Professional | | $1,808.17 | $2,328.77 | $3,572.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,580.28 / $1,580.28 / $1,917.48
| Professional | | $1,580.28 | $1,580.28 | $1,917.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,686.94 / $2,347.09 / $3,265.20
| Professional | | $1,686.94 | $2,347.09 | $3,265.20 |