- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,786.30 / $12,882.50
| Facility | | $2,041.74 | $4,786.30 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | 22 | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,365.16 / $5,888.44
| Facility | | $1,230.27 | $4,365.16 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,949.84 / $6,918.31
| Facility | | $891.25 | $1,949.84 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $7,244.36
| Facility | | $3,090.30 | $4,073.80 | $7,244.36 |