- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,155.88 / $4,608.52 / $8,767.66
| Facility | | $1,155.88 | $4,608.52 | $8,767.66 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $20,975.28 / $20,975.28 / $20,975.28
| Facility | 22 | $20,975.28 | $20,975.28 | $20,975.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $10,517.23
| Facility | | $3,248.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $1,574.05 / $2,172.58
| Facility | | $1,040.00 | $1,574.05 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |