- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $9,772.37
| Facility | | $2,754.23 | $5,495.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $977.24 / $2,818.38
| Professional | | $309.03 | $977.24 | $2,818.38 |
- 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
- $575.44 / $1,122.02 / $3,162.28
| Professional | | $575.44 | $1,122.02 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,047.13 / $3,019.95
| Professional | | $478.63 | $1,047.13 | $3,019.95 |
- 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
- $346.74 / $1,288.25 / $3,388.44
| Professional | | $346.74 | $1,288.25 | $3,388.44 |