- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $7,413.10 / $15,848.93
| Facility | | $891.25 | $7,413.10 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | 22 | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $645.65
| Facility | | $512.86 | $512.86 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,995.26 / $3,715.35
| Professional | | $1,778.28 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,388.44 / $5,888.44
| Facility | | $1,778.28 | $3,388.44 | $5,888.44 |