- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,888.44 / $9,549.93
| Facility | | $2,570.40 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,818.38 / $5,754.40
| Facility | | $912.01 | $2,818.38 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $616.60 / $831.76
| Facility | | $199.53 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,513.56
| Professional | | $630.96 | $812.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $2,290.87
| Professional | 22 | $1,778.28 | $1,778.28 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,677.35 / $8,511.38
| Facility | | $660.69 | $4,677.35 | $8,511.38 |