- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,413.10 / $12,882.50
| Facility | | $4,168.69 | $7,413.10 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $15,135.61
| Facility | | $2,137.96 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $10,000.00
| Facility | | $5,011.87 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $3,630.78
| Professional | | $1,096.48 | $1,348.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Professional | 22 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $13,803.84 / $70,794.58
| Facility | | $5,370.32 | $13,803.84 | $70,794.58 |