- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,570.88 / $8,511.38
| Facility | | $1,949.84 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $912.01 / $2,041.74
| Professional | | $162.18 | $912.01 | $2,041.74 |
- 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
- $199.53 / $630.96 / $2,511.89
| Professional | | $199.53 | $630.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $1,023.29 / $2,951.21
| Professional | | $213.80 | $1,023.29 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,445.44 / $2,238.72
| Professional | | $851.14 | $1,445.44 | $2,238.72 |
- 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
- $154.88 / $933.25 / $2,041.74
| Professional | | $154.88 | $933.25 | $2,041.74 |