- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.28 / $1,484.30 / $18,021.00
| Facility | | $894.28 | $1,484.30 | $18,021.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.98 / $3,596.26 / $19,515.09
| Professional | | $1,027.98 | $3,596.26 | $19,515.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,470.18 / $17,470.18 / $20,964.23
| Facility | | $17,470.18 | $17,470.18 | $20,964.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.71 / $984.87 / $11,270.04
| Professional | | $669.71 | $984.87 | $11,270.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,986.00 / $8,986.00 / $17,044.62
| Facility | | $8,986.00 | $8,986.00 | $17,044.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,022.54 / $14,031.56 / $21,346.21
| Professional | | $10,022.54 | $14,031.56 | $21,346.21 |