- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.33 / $3,588.64 / $7,265.35
| Facility | | $1,805.33 | $3,588.64 | $7,265.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,739.28 / $1,805.33 / $2,091.54
| Professional | | $1,739.28 | $1,805.33 | $2,091.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.42 / $6,604.86 / $11,952.59
| Facility | | $9.42 | $6,604.86 | $11,952.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $10.48 / $1,318.77
| Professional | | $8.00 | $10.48 | $1,318.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.62 / $2,752.03 / $43,749.56
| Facility | | $2,201.62 | $2,752.03 | $43,749.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,201.62 / $2,421.78 / $2,972.19
| Professional | | $2,201.62 | $2,421.78 | $2,972.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,431.05 / $4,160.84 / $8,586.49
| Facility | | $1,431.05 | $4,160.84 | $8,586.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.63 / $2,529.63 / $3,162.03
| Professional | | $2,529.63 | $2,529.63 | $3,162.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.68 / $1,320.97 / $2,419.58
| Professional | | $924.68 | $1,320.97 | $2,419.58 |