- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.81 / $533.37 / $2,434.73
| Professional | | $297.81 | $533.37 | $2,434.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,535.42 / $2,535.42 / $3,247.14
| Facility | | $2,535.42 | $2,535.42 | $3,247.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,329.88 / $2,746.42 / $5,242.59
| Professional | | $2,329.88 | $2,746.42 | $5,242.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.03 / $861.09 / $4,606.35
| Professional | | $468.03 | $861.09 | $4,606.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.03 / $670.67 / $3,816.87
| Professional | | $468.03 | $670.67 | $3,816.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.15 / $2,845.95 / $6,329.55
| Professional | | $1,560.15 | $2,845.95 | $6,329.55 |