- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.00 / $2,175.56 / $15,690.40
| Professional | | $2,043.00 | $2,175.56 | $15,690.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.84 / $185.84 / $1,021.01
| Professional | | $185.84 | $185.84 | $1,021.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.25 / $7,127.63 / $10,860.55
| Facility | | $1,805.25 | $7,127.63 | $10,860.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.54 / $462.64 / $2,365.17
| Professional | | $385.54 | $462.64 | $2,365.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.49 / $2,742.75 / $8,405.00
| Facility | | $426.49 | $2,742.75 | $8,405.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,800.02 / $3,656.36 / $9,233.84
| Professional | | $2,800.02 | $3,656.36 | $9,233.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.30 / $3,416.96 / $5,601.01
| Professional | | $2,709.30 | $3,416.96 | $5,601.01 |