- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.54 / $3,064.03 / $68,058.30
| Professional | | $757.54 | $3,064.03 | $68,058.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.58 / $574.58 / $648.72
| Professional | | $574.58 | $574.58 | $648.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,640.79 / $17,723.84 / $23,844.24
| Facility | | $14,640.79 | $17,723.84 | $23,844.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.54 / $10,390.26 / $16,327.55
| Professional | | $1,127.54 | $10,390.26 | $16,327.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,728.20 / $20,339.23 / $27,790.23
| Facility | | $18,728.20 | $20,339.23 | $27,790.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,168.47 / $14,900.71 / $21,548.74
| Professional | | $11,168.47 | $14,900.71 | $21,548.74 |