- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.33 / $3,520.18 / $4,356.66
| Professional | | $3,485.33 | $3,520.18 | $4,356.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $5,644.29 / $17,103.90
| Facility | | $1.00 | $5,644.29 | $17,103.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,368.57 / $8,666.24 / $15,683.40
| Professional | | $3,368.57 | $8,666.24 | $15,683.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $5,644.29 / $6,670.52
| Facility | | $1.00 | $5,644.29 | $6,670.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,093.52 / $3,900.54 / $8,020.72
| Professional | | $3,093.52 | $3,900.54 | $8,020.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $4,990.20 / $7,696.80
| Professional | | $27.40 | $4,990.20 | $7,696.80 |