- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,380.38 / $8,317.64
| Professional | | $602.56 | $1,380.38 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $47,863.01 / $97,723.72
| Facility | | $22,908.68 | $47,863.01 | $97,723.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $691.83 / $741.31
| Facility | | $630.96 | $691.83 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $9,549.93 / $17,378.01
| Facility | | $707.95 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,162.28 / $43,651.58
| Professional | | $2,511.89 | $3,162.28 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $22,387.21
| Facility | | $16,982.44 | $16,982.44 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $8,912.51 / $19,498.45
| Professional | | $707.95 | $8,912.51 | $19,498.45 |