- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.30 / $2,522.96 / $21,273.60
| Professional | | $808.30 | $2,522.96 | $21,273.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,009.79 / $19,215.57 / $32,191.20
| Facility | | $8,009.79 | $19,215.57 | $32,191.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.17 / $3,435.90 / $5,151.10
| Professional | | $596.17 | $3,435.90 | $5,151.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $867.41 / $4,337.05
| Professional | | $32.34 | $867.41 | $4,337.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,447.32 / $6,896.50 / $9,517.17
| Professional | | $5,447.32 | $6,896.50 | $9,517.17 |