- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $7,244.36 / $9,772.37
| Facility | | $398.11 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $371.54 / $398.11
| Professional | | $346.74 | $371.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $18,620.87 / $35,481.34
| Professional | | $15,848.93 | $18,620.87 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $63,095.73 / $125,892.54
| Facility | | $30,199.52 | $63,095.73 | $125,892.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,047.13
| Professional | | $346.74 | $512.86 | $1,047.13 |