- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.89 / $8,617.69 / $20,866.89
| Facility | | $1,154.89 | $8,617.69 | $20,866.89 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $10,485.00 / $10,485.00 / $14,714.61
| Facility | 22 | $10,485.00 | $10,485.00 | $14,714.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.00 / $2,851.07 / $3,394.13
| Facility | | $432.00 | $2,851.07 | $3,394.13 |
- 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 |