- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,495.41 / $9,549.93
| Facility | | $2,041.74 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $933.25 / $2,511.89
| Professional | | $331.13 | $933.25 | $2,511.89 |
- 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
- $562.34 / $1,288.25 / $2,884.03
| Professional | | $562.34 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $977.24 / $3,467.37
| Professional | | $478.63 | $977.24 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $3,235.94
| Professional | | $1,905.46 | $1,905.46 | $3,235.94 |
- 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
- $371.54 / $1,380.38 / $3,890.45
| Professional | | $371.54 | $1,380.38 | $3,890.45 |