- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.96 / $7,500.00 / $15,975.72
| Facility | | $721.96 | $7,500.00 | $15,975.72 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $15,718.20 / $15,718.20 / $15,718.20
| Facility | 22 | $15,718.20 | $15,718.20 | $15,718.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,138.19 / $3,138.19 / $4,340.00
| Facility | | $3,138.19 | $3,138.19 | $4,340.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,530.09 / $9,087.95 / $26,521.76
| Facility | | $4,530.09 | $9,087.95 | $26,521.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,783.00 / $2,783.00
| Facility | | $1,924.00 | $2,783.00 | $2,783.00 |