- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.29 / $2,796.55 / $10,193.50
| Facility | | $2,054.29 | $2,796.55 | $10,193.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.81 / $2,306.23 / $2,519.41
| Professional | | $1,162.81 | $2,306.23 | $2,519.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.48 / $3,784.74 / $5,963.64
| Facility | | $2,098.48 | $3,784.74 | $5,963.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.96 / $180.36 / $182.00
| Professional | | $163.96 | $180.36 | $182.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.01 / $1,938.01 / $1,938.01
| Facility | | $1,938.01 | $1,938.01 | $1,938.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.87 / $3,717.79 / $13,687.67
| Facility | | $2,027.87 | $3,717.79 | $13,687.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $1,162.81 / $2,422.51
| Professional | | $813.96 | $1,162.81 | $2,422.51 |