- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,153.00 / $11,769.61 / $41,345.28
| Facility | | $3,153.00 | $11,769.61 | $41,345.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $16,395.16 / $16,395.16 / $38,893.91
| Facility | 22 | $16,395.16 | $16,395.16 | $38,893.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,880.16 / $15,043.00 / $65,975.00
| Facility | | $4,880.16 | $15,043.00 | $65,975.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,855.00 / $12,742.00 / $23,031.00
| Facility | | $5,855.00 | $12,742.00 | $23,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,072.00 / $12,923.00 / $19,866.00
| Facility | | $4,072.00 | $12,923.00 | $19,866.00 |