- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,570.40 / $8,709.64
| Facility | | $512.86 | $2,570.40 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $7,762.47
| Facility | 22 | $3,801.89 | $3,801.89 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,762.47 / $10,471.29
| Facility | | $4,570.88 | $7,762.47 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $6,918.31 / $10,000.00
| Facility | | $398.11 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,412.54 / $2,630.27
| Professional | | $501.19 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,168.69 / $7,585.78
| Facility | | $1,096.48 | $4,168.69 | $7,585.78 |