- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.37 / $9,497.67 / $16,930.37
| Facility | | $955.37 | $9,497.67 | $16,930.37 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $10,259.77 / $10,259.77 / $10,259.77
| Facility | 22 | $10,259.77 | $10,259.77 | $10,259.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,860.97 / $9,162.24 / $12,413.37
| Facility | | $7,860.97 | $9,162.24 | $12,413.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.44 / $8,098.47 / $16,405.28
| Facility | | $1,146.44 | $8,098.47 | $16,405.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $10,259.77 / $10,259.77 / $10,259.77
| Facility | 22 | $10,259.77 | $10,259.77 | $10,259.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $10,359.00 / $12,767.00
| Facility | | $4,700.00 | $10,359.00 | $12,767.00 |