- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $6,002.62
| Facility | | $100.00 | $2,331.21 | $6,002.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,251.78 / $1,251.78 / $2,317.01
| Facility | 22 | $1,251.78 | $1,251.78 | $2,317.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $3,669.21 / $6,000.00
| Facility | | $3,302.10 | $3,669.21 | $6,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.14 / $2,000.36 / $2,070.38
| Facility | | $784.14 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,949.00 / $9,949.00 / $9,949.00
| Facility | | $9,949.00 | $9,949.00 | $9,949.00 |