- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,370.32 / $9,549.93
| Facility | | $2,511.89 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $6,760.83
| Facility | | $851.14 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $588.84 / $831.76
| Facility | | $199.53 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $4,466.84
| Professional | | $1,862.09 | $2,398.83 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $6,760.83
| Professional | 22 | $5,370.32 | $5,370.32 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $141.25 / $141.25 / $181.97
| Professional | 80 | $141.25 | $141.25 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,511.89 / $7,079.46
| Facility | | $398.11 | $2,511.89 | $7,079.46 |