- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,073.80 / $9,332.54
| Facility | | $812.83 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $10,000.00
| Facility | | $34.67 | $398.11 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | 22 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,623.41 / $9,772.37
| Facility | | $1,737.80 | $5,623.41 | $9,772.37 |