- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.58 / $2,271.78 / $18,681.90
| Professional | | $728.58 | $2,271.78 | $18,681.90 |
- 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
- $537.75 / $3,250.92 / $4,631.22
| Professional | | $537.75 | $3,250.92 | $4,631.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $776.75 / $3,996.65
| Professional | | $32.34 | $776.75 | $3,996.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,784.84 / $5,859.01 / $7,909.64
| Professional | | $4,784.84 | $5,859.01 | $7,909.64 |