- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $2,951.21 / $4,073.80
| Professional | | $165.96 | $2,951.21 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $8,128.31
| Professional | | $407.38 | $549.54 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $5,370.32 / $9,772.37
| Professional | | $346.74 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,244.36 / $8,912.51
| Professional | | $4,168.69 | $7,244.36 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $2,884.03 / $8,511.38
| Professional | | $223.87 | $2,884.03 | $8,511.38 |