- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.42 / $8,068.00 / $37,819.28
| Facility | | $1,387.42 | $8,068.00 | $37,819.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $11,561.00 / $11,561.00 / $11,561.00
| Facility | 22 | $11,561.00 | $11,561.00 | $11,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.00 / $18,485.00 / $60,320.00
| Facility | | $9,496.00 | $18,485.00 | $60,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,846.00 / $25,832.50 / $34,424.00
| Facility | | $13,846.00 | $25,832.50 | $34,424.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,546.50 / $25,871.00 / $68,964.50
| Facility | | $9,546.50 | $25,871.00 | $68,964.50 |