- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $22,387.21 / $22,387.21
| Facility | | $371.54 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $380.19
| Professional | | $371.54 | $371.54 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,772.37 / $30,902.95
| Facility | | $7,943.28 | $9,772.37 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $44.67 / $79.43
| Professional | | $32.36 | $44.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $26,302.68 / $37,153.52
| Facility | | $14,125.38 | $26,302.68 | $37,153.52 |