- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,888.44 / $10,964.78
| Facility | | $3,019.95 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $741.31 / $3,981.07
| Professional | | $165.96 | $741.31 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,302.69 / $13,803.84
| Facility | | $7,413.10 | $12,302.69 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $2,041.74 / $4,677.35
| Professional | | $234.42 | $2,041.74 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $794.33 / $6,025.60
| Professional | | $251.19 | $794.33 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $5,128.61
| Professional | | $2,630.27 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,709.64 / $11,748.98
| Facility | | $5,754.40 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $707.95 / $5,128.61
| Professional | | $199.53 | $707.95 | $5,128.61 |