- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.65 / $2,969.53 / $49,763.10
| Professional | | $730.65 | $2,969.53 | $49,763.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.86 / $557.86 / $779.81
| Professional | | $557.86 | $557.86 | $779.81 |
- 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
- $1,094.73 / $7,632.86 / $11,994.49
| Professional | | $1,094.73 | $7,632.86 | $11,994.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,381.53 / $11,292.93 / $18,204.39
| Professional | | $8,381.53 | $11,292.93 | $18,204.39 |