- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,079.46 / $23,442.29
| Facility | | $1,584.89 | $7,079.46 | $23,442.29 |
- 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
- $7,244.36 / $15,488.17 / $23,988.33
| Facility | | $7,244.36 | $15,488.17 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,089.30 / $5,248.07
| Professional | | $1,202.26 | $2,089.30 | $5,248.07 |
- 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
- $2,570.40 / $7,943.28 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |