- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.94 / $1,697.91 / $6,434.03
| Professional | | $824.94 | $1,697.91 | $6,434.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.99 / $11,500.00 / $12,000.00
| Facility | | $876.99 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.61 / $6,324.33 / $6,324.33
| Professional | | $2,273.61 | $6,324.33 | $6,324.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.70 / $1,000.58 / $2,291.44
| Facility | | $392.70 | $1,000.58 | $2,291.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $511.40 / $3,054.70
| Professional | | $4.00 | $511.40 | $3,054.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.70 / $1,000.58 / $2,319.52
| Facility | | $392.70 | $1,000.58 | $2,319.52 |