- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $5,495.41 / $9,549.93
| Facility | | $794.33 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,047.13 / $2,089.30
| Professional | | $371.54 | $1,047.13 | $2,089.30 |
- 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
- $645.65 / $1,202.26 / $3,235.94
| Professional | | $645.65 | $1,202.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,096.48 / $2,884.03
| Professional | | $549.54 | $1,096.48 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,691.53
| Professional | | $2,137.96 | $2,137.96 | $2,691.53 |
- 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
- $426.58 / $1,348.96 / $3,388.44
| Professional | | $426.58 | $1,348.96 | $3,388.44 |