- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.38 / $5,063.00 / $9,512.00
| Facility | | $1,167.38 | $5,063.00 | $9,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.76 / $9,558.66 / $54,438.64
| Facility | | $2,325.76 | $9,558.66 | $54,438.64 |
- 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
- $1,156.97 / $1,619.76 / $3,830.09
| Professional | | $1,156.97 | $1,619.76 | $3,830.09 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $7,131.59 / $7,131.59 / $7,131.59
| Professional | 22 | $7,131.59 | $7,131.59 | $7,131.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,303.00 / $10,133.00 / $20,037.00
| Facility | | $2,303.00 | $10,133.00 | $20,037.00 |