- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.03 / $4,521.00 / $8,447.00
| Facility | | $1,629.03 | $4,521.00 | $8,447.00 |
- 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
- $1,341.54 / $5,501.86 / $8,070.83
| Facility | | $1,341.54 | $5,501.86 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.73 / $1,418.30 / $6,124.00
| Facility | | $882.73 | $1,418.30 | $6,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |