- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $7,244.36 / $18,197.01
| Facility | | $616.60 | $7,244.36 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,071.52 / $1,621.81
| Professional | | $645.65 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $660.69 / $954.99
| Professional | | $524.81 | $660.69 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,709.64 / $18,197.01
| Facility | | $8,317.64 | $8,709.64 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,071.52 / $1,122.02
| Professional | | $588.84 | $1,071.52 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $676.08 / $1,548.82
| Professional | | $588.84 | $676.08 | $1,548.82 |