- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.00 / $3,606.44 / $10,073.00
| Facility | | $1,207.00 | $3,606.44 | $10,073.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $40,704.37 / $40,704.37 / $40,704.37
| Facility | 22 | $40,704.37 | $40,704.37 | $40,704.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,449.44 / $24,490.80 / $49,042.82
| Facility | | $11,449.44 | $24,490.80 | $49,042.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $11,477.00 / $12,682.00
| Facility | | $875.00 | $11,477.00 | $12,682.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,027.40 / $3,225.41 / $7,509.20
| Professional | | $2,027.40 | $3,225.41 | $7,509.20 |
- 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
- $1,300.00 / $5,978.00 / $12,241.00
| Facility | | $1,300.00 | $5,978.00 | $12,241.00 |