- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,888.44 / $14,454.40
| Facility | | $1,288.25 | $5,888.44 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 22 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,606.93 / $14,125.38
| Facility | | $3,235.94 | $6,606.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,511.89 / $6,025.60
| Facility | | $831.76 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | 22 | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |