- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,495.41 / $9,549.93
| Facility | | $2,630.27 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,230.27 / $2,238.72
| Professional | | $338.84 | $1,230.27 | $2,238.72 |
- 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
- $660.69 / $1,071.52 / $4,073.80
| Professional | | $660.69 | $1,071.52 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,096.48 / $3,467.37
| Professional | | $457.09 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,951.21
| Professional | | $2,398.83 | $2,398.83 | $2,951.21 |
- 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
- $407.38 / $1,348.96 / $3,388.44
| Professional | | $407.38 | $1,348.96 | $3,388.44 |