- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.78 / $4,100.00 / $28,466.69
| Facility | | $1,086.78 | $4,100.00 | $28,466.69 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $11,306.53 / $11,306.53 / $11,306.53
| Facility | 22 | $11,306.53 | $11,306.53 | $11,306.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,788.02 / $13,498.87 / $19,342.58
| Facility | | $7,788.02 | $13,498.87 | $19,342.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,950.90 / $10,950.90 / $10,950.90
| Facility | | $10,950.90 | $10,950.90 | $10,950.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.00 / $5,780.00 / $12,353.00
| Facility | | $1,284.00 | $5,780.00 | $12,353.00 |