- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,631.57 / $15,631.57 / $16,608.54
| Professional | | $15,631.57 | $15,631.57 | $16,608.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $17,259.84 / $18,236.83
| Facility | | $16,608.54 | $17,259.84 | $18,236.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,585.50 / $17,585.50 / $17,585.50
| Professional | | $17,585.50 | $17,585.50 | $17,585.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Facility | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Professional | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.88 / $16,282.88 / $16,282.88
| Professional | | $16,282.88 | $16,282.88 | $16,282.88 |