- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,351.06 / $5,063.00 / $7,265.22
| Facility | | $3,351.06 | $5,063.00 | $7,265.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.76 / $8,967.21 / $21,657.35
| Facility | | $2,325.76 | $8,967.21 | $21,657.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $550.00
| Facility | | $550.00 | $550.00 | $550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,283.05 / $4,596.27 / $6,943.50
| Professional | | $3,283.05 | $4,596.27 | $6,943.50 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $11,393.38 / $11,393.38 / $11,393.38
| Professional | 22 | $11,393.38 | $11,393.38 | $11,393.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.00 / $3,629.00 / $10,000.00
| Facility | | $607.00 | $3,629.00 | $10,000.00 |