- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.52 / $3,570.50 / $8,364.50
| Facility | | $775.52 | $3,570.50 | $8,364.50 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,486.70 / $3,486.70 / $3,486.70
| Facility | 22 | $3,486.70 | $3,486.70 | $3,486.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $5,379.00 / $12,173.00
| Facility | | $1,755.00 | $5,379.00 | $12,173.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.36 / $1,617.27 / $6,096.00
| Facility | | $541.36 | $1,617.27 | $6,096.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,099.00 / $3,399.00 / $7,285.50
| Facility | | $1,099.00 | $3,399.00 | $7,285.50 |