- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $2,570.40 / $7,762.47
| Professional | | $323.59 | $2,570.40 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,548.13 / $3,981.07
| Facility | | $2,818.38 | $3,548.13 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $2,344.23
| Professional | | $1,737.80 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,511.38 / $9,549.93
| Facility | | $5,495.41 | $8,511.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $8,709.64
| Professional | | $1,778.28 | $2,511.89 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $4,466.84
| Professional | | $1,318.26 | $1,862.09 | $4,466.84 |