- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $2,137.96 / $3,235.94
| Professional | | $575.44 | $2,137.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,011.87 / $7,244.36
| Facility | | $2,238.72 | $5,011.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $741.31 / $741.31
| Professional | | $416.87 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,995.26 / $3,467.37
| Facility | | $1,862.09 | $1,995.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,096.48
| Professional | | $398.11 | $758.58 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,318.26 / $5,370.32
| Professional | | $489.78 | $1,318.26 | $5,370.32 |