- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.04 / $7,407.35 / $18,523.04
| Facility | | $889.04 | $7,407.35 | $18,523.04 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $14,521.45 / $14,521.45 / $14,521.45
| Facility | 22 | $14,521.45 | $14,521.45 | $14,521.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $507.00 / $641.21
| Facility | | $507.00 | $507.00 | $641.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,899.44 / $2,492.60 / $3,832.52
| Professional | | $1,899.44 | $2,492.60 | $3,832.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,403.00 / $3,403.00 / $5,108.00
| Facility | | $3,403.00 | $3,403.00 | $5,108.00 |