- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $7,079.46 / $27,542.29
| Facility | | $1,862.09 | $7,079.46 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $20,417.38 / $20,417.38 / $20,417.38
| Facility | 22 | $20,417.38 | $20,417.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $20,417.38 / $39,810.72
| Facility | | $7,585.78 | $20,417.38 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $588.84
| Facility | | $398.11 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,981.07 / $10,471.29
| Professional | | $1,905.46 | $3,981.07 | $10,471.29 |
- 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
- $1,659.59 / $6,760.83 / $14,125.38
| Facility | | $1,659.59 | $6,760.83 | $14,125.38 |