- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.92 / $2,466.69 / $2,952.36
| Facility | | $2,009.92 | $2,466.69 | $2,952.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,306.62 / $2,495.77 / $2,616.01
| Professional | | $2,306.62 | $2,495.77 | $2,616.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.52 / $1,310.00 / $3,500.00
| Facility | | $837.52 | $1,310.00 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.64 / $897.49 / $1,265.33
| Professional | | $208.64 | $897.49 | $1,265.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,686.80 / $2,951.14 / $4,832.71
| Facility | | $1,686.80 | $2,951.14 | $4,832.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.51 / $1,884.11 / $2,730.46
| Professional | | $1,461.51 | $1,884.11 | $2,730.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,926.08 / $2,682.50 / $3,697.68
| Facility | | $1,926.08 | $2,682.50 | $3,697.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.09 / $1,110.49 / $1,987.99
| Professional | | $108.09 | $1,110.49 | $1,987.99 |