- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.71 / $6,478.45 / $25,186.52
| Facility | | $1,586.71 | $6,478.45 | $25,186.52 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,026.02 / $9,175.16 / $20,572.75
| Facility | 22 | $5,026.02 | $9,175.16 | $20,572.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,420.83 / $15,736.64 / $28,433.29
| Facility | | $7,420.83 | $15,736.64 | $28,433.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $908.00
| Facility | | $875.00 | $875.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.43 / $2,104.00 / $4,746.58
| Professional | | $1,313.43 | $2,104.00 | $4,746.58 |
- 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
- $1,602.00 / $7,500.00 / $14,716.00
| Facility | | $1,602.00 | $7,500.00 | $14,716.00 |