- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.47 / $1,238.00 / $4,279.68
| Facility | | $248.47 | $1,238.00 | $4,279.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.80 / $679.06 / $4,452.72
| Professional | | $160.80 | $679.06 | $4,452.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,715.59 / $6,936.13 / $9,331.32
| Facility | | $5,715.59 | $6,936.13 | $9,331.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.40 / $2,219.39 / $3,741.26
| Professional | | $163.40 | $2,219.39 | $3,741.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.96 / $298.24 / $5,178.22
| Professional | | $154.96 | $298.24 | $5,178.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.00 / $4,852.00 / $9,624.00
| Facility | | $1,404.00 | $4,852.00 | $9,624.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,357.28 / $3,300.19 / $4,964.02
| Professional | | $2,357.28 | $3,300.19 | $4,964.02 |