- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,588.50 / $3,770.00 / $8,407.00
| Facility | | $1,588.50 | $3,770.00 | $8,407.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,932.00 / $4,932.00 / $4,932.00
| Facility | 22 | $4,932.00 | $4,932.00 | $4,932.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.17 / $2,713.13 / $4,140.09
| Facility | | $688.17 | $2,713.13 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.26 / $899.63 / $6,063.00
| Facility | | $665.26 | $899.63 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,766.54 / $3,981.00 / $7,217.00
| Facility | | $2,766.54 | $3,981.00 | $7,217.00 |