- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,212.94 / $8,730.86 / $18,852.00
| Facility | | $2,212.94 | $8,730.86 | $18,852.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $16,370.32 / $16,370.32 / $16,370.32
| Facility | 22 | $16,370.32 | $16,370.32 | $16,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.07 / $11,754.00 / $30,357.00
| Facility | | $2,851.07 | $11,754.00 | $30,357.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,979.00 / $12,759.00 / $23,031.00
| Facility | | $5,979.00 | $12,759.00 | $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 |