- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $20,417.38 / $25,118.86
| Professional | | $1,445.44 | $20,417.38 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $6,606.93 / $21,379.62
| Facility | | $912.01 | $6,606.93 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $16,595.87 / $64,565.42
| Professional | | $8,912.51 | $16,595.87 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,584.89 / $23,442.29
| Professional | | $1,479.11 | $1,584.89 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $12,589.25 / $16,218.10
| Professional | | $1,122.02 | $12,589.25 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,862.09 / $27,542.29
| Professional | | $851.14 | $1,862.09 | $27,542.29 |