- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.38 / $831.01 / $5,582.58
| Professional | | $208.38 | $831.01 | $5,582.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.11 / $212.11 / $223.83
| Professional | | $212.11 | $212.11 | $223.83 |
- 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
- $175.24 / $858.31 / $1,348.77
| Professional | | $175.24 | $858.31 | $1,348.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.84 / $1,206.49 / $1,685.42
| Professional | | $786.84 | $1,206.49 | $1,685.42 |