- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.68 / $1,251.83 / $9,405.57
| Facility | | $867.68 | $1,251.83 | $9,405.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.26 / $2,769.13 / $25,144.60
| Professional | | $976.26 | $2,769.13 | $25,144.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $9,750.00 / $17,774.00
| Facility | | $4,989.00 | $9,750.00 | $17,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.14 / $3,671.27 / $7,999.96
| Professional | | $656.14 | $3,671.27 | $7,999.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,664.23 / $13,751.11 / $27,973.01
| Facility | | $10,664.23 | $13,751.11 | $27,973.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.19 / $1,269.64 / $10,466.93
| Professional | | $878.19 | $1,269.64 | $10,466.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,057.84 / $12,057.84 / $12,057.84
| Facility | | $12,057.84 | $12,057.84 | $12,057.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,914.60 / $7,498.37 / $11,642.71
| Professional | | $4,914.60 | $7,498.37 | $11,642.71 |