- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.82 / $2,737.37 / $9,977.84
| Facility | | $2,010.82 | $2,737.37 | $9,977.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.20 / $2,295.37 / $2,466.10
| Professional | | $1,138.20 | $2,295.37 | $2,466.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.07 / $3,704.65 / $5,837.45
| Facility | | $2,054.07 | $3,704.65 | $5,837.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.30 / $165.36 / $166.87
| Professional | | $135.30 | $165.36 | $166.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.00 / $1,897.00 / $1,897.00
| Facility | | $1,897.00 | $1,897.00 | $1,897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,985.14 / $3,639.47 / $13,398.08
| Facility | | $1,985.14 | $3,639.47 | $13,398.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.74 / $1,081.48 / $2,655.80
| Professional | | $796.74 | $1,081.48 | $2,655.80 |