- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $8,128.31 / $13,182.57
| Facility | | $1,412.54 | $8,128.31 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 22 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,318.26 / $2,398.83
| Professional | | $1,174.90 | $1,318.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |