- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,388.44 / $4,168.69
| Professional | | $3,162.28 | $3,388.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $4,786.30
| Facility | | $416.87 | $416.87 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $5,248.07
| Professional | | $446.68 | $446.68 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,897.79 / $9,772.37
| Facility | | $1,445.44 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $3,467.37 / $29,512.09
| Professional | | $501.19 | $3,467.37 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,090.30 / $4,897.79
| Facility | | $407.38 | $3,090.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,548.13 / $5,495.41
| Professional | | $2,691.53 | $3,548.13 | $5,495.41 |