- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.31 / $576.46 / $6,115.36
| Facility | | $164.31 | $576.46 | $6,115.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.93 / $333.39 / $3,912.10
| Professional | | $146.93 | $333.39 | $3,912.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.14 / $330.71 / $4,353.76
| Professional | | $197.14 | $330.71 | $4,353.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.36 / $3,408.35 / $5,005.64
| Professional | | $215.36 | $3,408.35 | $5,005.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.17 / $496.29 / $4,913.63
| Professional | | $215.17 | $496.29 | $4,913.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.46 / $6,115.36 / $11,010.12
| Facility | | $576.46 | $6,115.36 | $11,010.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.31 / $321.04 / $3,967.54
| Professional | | $164.31 | $321.04 | $3,967.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,836.87 / $4,817.50 / $5,522.67
| Professional | | $2,836.87 | $4,817.50 | $5,522.67 |