- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,248.07 / $12,589.25
| Facility | | $977.24 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,258.93 / $5,888.44 / $14,454.40
| Facility | 22 | $1,258.93 | $5,888.44 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,709.64 / $16,218.10
| Facility | | $3,311.31 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,089.30 / $10,000.00
| Facility | | $1,023.29 | $2,089.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 22 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |