- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.80 / $4,433.76 / $9,507.55
| Facility | | $1,262.80 | $4,433.76 | $9,507.55 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,229.50 / $9,229.50 / $9,229.50
| Facility | 22 | $9,229.50 | $9,229.50 | $9,229.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,407.00 / $6,548.00 / $13,989.00
| Facility | | $3,407.00 | $6,548.00 | $13,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,655.95 / $3,440.72 / $12,188.09
| Facility | | $1,655.95 | $3,440.72 | $12,188.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,920.00 / $9,949.00
| Facility | | $2,637.00 | $5,920.00 | $9,949.00 |