- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,273.97 / $5,063.00 / $7,484.52
| Facility | | $4,273.97 | $5,063.00 | $7,484.52 |
- 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
- $4,249.02 / $5,948.63 / $7,963.09
| Professional | | $4,249.02 | $5,948.63 | $7,963.09 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $14,745.61 / $14,745.61 / $14,745.61
| Professional | 22 | $14,745.61 | $14,745.61 | $14,745.61 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $393.22 / $393.22 / $393.22
| Professional | 80 | $393.22 | $393.22 | $393.22 |
- 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 |