- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.81 / $1,083.45 / $10,435.50
| Professional | | $340.81 | $1,083.45 | $10,435.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.01 / $348.01 / $348.01
| Professional | | $348.01 | $348.01 | $348.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,266.85 / $14,169.57 / $19,903.24
| Facility | | $6,266.85 | $14,169.57 | $19,903.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.13 / $423.01 / $3,033.27
| Professional | | $291.13 | $423.01 | $3,033.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,827.86 / $3,059.65 / $4,867.38
| Professional | | $1,827.86 | $3,059.65 | $4,867.38 |