- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.31 / $2,312.19 / $2,412.71
| Professional | | $1,671.31 | $2,312.19 | $2,412.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.55 / $631.00 / $6,781.50
| Professional | | $203.55 | $631.00 | $6,781.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,518.55 / $3,644.21 / $6,031.80
| Facility | | $3,518.55 | $3,644.21 | $6,031.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.63 / $6,082.07 / $14,145.57
| Professional | | $1,256.63 | $6,082.07 | $14,145.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,261.92 / $3,267.23 / $5,866.29
| Professional | | $2,261.92 | $3,267.23 | $5,866.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,091.30 / $3,644.21 / $6,088.50
| Professional | | $3,091.30 | $3,644.21 | $6,088.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.57 / $1,507.95 / $3,644.21
| Professional | | $1,055.57 | $1,507.95 | $3,644.21 |