- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,758.04 / $12,790.61
| Facility | | $1,700.00 | $4,758.04 | $12,790.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $8,865.61 / $8,865.61 / $8,865.61
| Facility | 22 | $8,865.61 | $8,865.61 | $8,865.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,781.25 / $5,304.39 / $11,561.72
| Facility | | $1,781.25 | $5,304.39 | $11,561.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,432.00 / $11,432.00 / $11,432.00
| Facility | | $11,432.00 | $11,432.00 | $11,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.36 / $1,310.10 / $8,038.00
| Facility | | $708.36 | $1,310.10 | $8,038.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $12,989.00
| Facility | | $2,269.00 | $6,170.00 | $12,989.00 |