- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $9,120.11 / $16,595.87
| Facility | | $537.03 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,202.26 / $1,949.84
| Professional | | $537.03 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $14,454.40 / $24,547.09
| Facility | | $7,585.78 | $14,454.40 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $2,454.71
| Facility | | $537.03 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $11,220.18 / $16,982.44
| Facility | | $2,754.23 | $11,220.18 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $2,089.30 / $3,630.78
| Professional | | $776.25 | $2,089.30 | $3,630.78 |