- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $7,079.46 / $21,877.62
| Facility | | $870.96 | $7,079.46 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | 22 | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $2,041.74
| Professional | | $512.86 | $691.83 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $12,302.69 / $30,199.52
| Facility | | $4,570.88 | $12,302.69 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,445.44
| Professional | | $478.63 | $776.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $12,022.64 / $33,884.42
| Facility | | $870.96 | $12,022.64 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 22 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $851.14 / $1,737.80
| Professional | | $524.81 | $851.14 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $15,135.61 / $39,810.72
| Facility | | $4,466.84 | $15,135.61 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,288.25
| Professional | | $478.63 | $691.83 | $1,288.25 |