- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $7,079.46
| Professional | | $831.76 | $1,174.90 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,311.31 / $6,456.54
| Facility | | $524.81 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,495.41 / $18,197.01
| Professional | | $2,511.89 | $5,495.41 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $912.01 / $6,606.93
| Professional | | $851.14 | $912.01 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $3,801.89 / $5,248.07
| Professional | | $645.65 | $3,801.89 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,071.52 / $7,762.47
| Professional | | $501.19 | $1,071.52 | $7,762.47 |