- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.00 / $5,909.00 / $10,726.00
| Facility | | $1,374.00 | $5,909.00 | $10,726.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,859.00 / $4,859.00 / $4,859.00
| Facility | 22 | $4,859.00 | $4,859.00 | $4,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,264.00 / $12,274.00
| Facility | | $4,452.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,659.03 / $2,820.06 / $3,619.61
| Facility | | $2,659.03 | $2,820.06 | $3,619.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |