- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,011.87 / $11,748.98
| Facility | | $1,202.26 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | 22 | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,317.64 / $15,488.17
| Facility | | $3,090.30 | $8,317.64 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,398.83 / $6,165.95
| Facility | | $1,445.44 | $2,398.83 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | 22 | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |