- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,300.00 / $7,936.00 / $13,095.00
| Facility | | $2,300.00 | $7,936.00 | $13,095.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,756.00 / $6,166.00 / $7,276.00
| Facility | 22 | $5,756.00 | $6,166.00 | $7,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,285.10 / $9,028.32 / $10,733.84
| Facility | | $3,285.10 | $9,028.32 | $10,733.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.95 / $1,779.13 / $9,507.00
| Facility | | $882.95 | $1,779.13 | $9,507.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $13,689.00
| Facility | | $2,269.00 | $6,170.00 | $13,689.00 |