- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $9,549.93
| Facility | | $3,162.28 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $616.60 / $3,630.78
| Professional | | $218.78 | $616.60 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $15,135.61 / $16,595.87
| Facility | | $8,317.64 | $15,135.61 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,995.26 / $5,888.44
| Professional | | $407.38 | $1,995.26 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $691.83 / $5,495.41
| Professional | | $295.12 | $691.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $4,466.84
| Professional | | $3,801.89 | $3,801.89 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $18,620.87
| Facility | | $7,244.36 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $1,949.84 / $5,754.40
| Professional | | $257.04 | $1,949.84 | $5,754.40 |