- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,981.07 / $6,760.83
| Facility | | $1,584.89 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | 22 | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,621.81 / $4,466.84
| Professional | | $891.25 | $1,621.81 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,137.96 / $11,481.54
| Facility | | $1,023.29 | $2,137.96 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | AS | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,137.96 / $2,570.40
| Professional | | $1,584.89 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $10,471.29 / $16,218.10
| Facility | | $5,011.87 | $10,471.29 | $16,218.10 |