- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,511.89 / $7,762.47
| Facility | | $537.03 | $2,511.89 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $2,290.87 / $23,442.29
| Professional | | $426.58 | $2,290.87 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,709.64 / $10,471.29
| Facility | | $7,585.78 | $8,709.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $346.74
| Professional | | $120.23 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,456.54 / $15,488.17
| Facility | | $2,570.40 | $6,456.54 | $15,488.17 |